Transactions of the Royal Society of Tropical Medicine and Hygiene
August 22, 2026 · via Europe PMC
Chronic erythema nodosum leprosum in Hansen's disease: a challenging clinical management.
Spinicci M, Barbiero A, Manciulli T, +8 more, Bartoloni A
AI summary — for doctors, generated from the abstract only
A case report describes a patient with years of relapsing, hard-to-control leprosy-related skin and systemic inflammation (chronic ENL) who finally achieved sustained remission using a combination of steroids, high-dose thalidomide, and clofazimine after multiple other drugs failed.
What was studied
A case report of a 34-year-old man with multibacillary Hansen's disease (leprosy) who developed chronic erythema nodosum leprosum requiring six years of recurrent hospitalizations despite multiple immunomodulatory treatments.
Key findings
- Corticosteroids, thalidomide, azathioprine, methotrexate, and anti-TNF-alpha therapy each provided only incomplete control over six years.
- A combination of methylprednisolone, high-dose thalidomide, and clofazimine achieved sustained remission.
- This remission allowed gradual discontinuation of treatment after years of steroid dependence.
Clinical relevance
Dermatologists and physicians managing refractory chronic ENL, a difficult leprosy complication relevant to leprosy-endemic regions including India, can consider this combination regimen when standard immunomodulatory therapies and even anti-TNF agents have failed.
Limitations
This is a single case report, so the regimen's effectiveness and safety cannot be generalized without further case series or controlled studies.
For patients with chronic ENL refractory to standard therapies including anti-TNF agents, consider a combination of corticosteroids, high-dose thalidomide, and clofazimine as a potential salvage regimen.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
INTRODUCTION
Chronic erythema nodosum leprosum (ENL) is a challenging complication of Hansen's disease (HD), with limited treatment options and frequent steroid dependence. Anti-tumour necrosis factor (TNF)-α agents are promising alternatives, though evidence remains confined to a few reports.
CASE DESCRIPTION
We report the case of a 34-year-old Moroccan man with multibacillary Hansen's disease, who developed chronic ENL with recurrent systemic and cutaneous flares, requiring prolonged immunomodulatory therapy. Corticosteroids, thalidomide, azathioprine, methotrexate, and anti-TNF-α therapy only provided incomplete control. After six years of recurrences requiring several hospitalizations, treatment with methylprednisolone, high-dose thalidomide, and clofazimine achieved a sustained remission, allowing gradual treatment discontinuation.
DOI
10.1093/trstmh/trag091
PMID
42631419
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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