Treatment of Recurrent Erythema Nodosum Leprosum with Infliximab

Abstract

A 52-year-old woman with multibacillary (borderline lepromatous) leprosy, who had been treated intermittently with dapsone since 1965, presented to our department in 1996 with active skin lesions, a positive bacterial index (5+) on skin biopsy, and an elevated level of antibodies against Mycobacterium leprae specific to phenolic glycolipid I. She was treated with multidrug therapy (rifampin, dapsone, and clofazimine). One and a half years after treatment was started, disseminated painful erythematous nodules and plaques, or erythema nodosum leprosum, developed owing to an augmented immunologic response to mycobacterial antigens. These symptoms did not respond adequately to repeated courses of prednisolone (40 mg once daily), thalidomide (starting dose, 300 mg daily), and pentoxifylline (400 mg three times daily). It was not possible to discontinue the immunomodulating treatment because of the frequent reactivation of the erythema nodosum leprosum. Given the severity of the patient's symptoms despite the use of standard therapies, we considered alternative management strategies.