01922nas a2200217   4500000000100000008004100001653001300042653001200055653002400067653001900091100001700110700002200127700001200149700001100161245008300172856008800255300001400343490000700357520132600364022001401690       2017                            d10aReaction10aleprosy10alepromatous leprosy10aCorticosteroid1 aJitendra SSV1 aBachaspatimayum R1 aDevi SA1 aRita S00aAzathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report.  uhttp://jcdr.net/articles/PDF/10499/26536_CE(RA1)_F(T)_PF1_(SY_MJ_PY)_PFA(SY_SS).pdf  aFD01-FD020 v113 a<p>Erythema Nodosum Leprosum (ENL) may have a chronic course which may be recalcitrant to treatment. Preferred treatment modalities are systemic corticosteroids and thalidomide. Azathioprine, methotrexate and cyclosporine are immunosuppressants which may also be used as a steroid sparing agent. We report the case of a 48-year-old male diagnosed as lepromatous leprosy that developed ENL after four months of Multibacillary Multi-Drug Therapy (MB-MDT). He was treated with oral prednisolone (1 mg/kg/day) which was gradually tapered upto a dose of 7.5 mg/day. He developed recurrences on and off once the dose reached the said level and this continued for three years. Oral clofazamine (300 mg/day x 6 months; then 100 mg/day x 6 months) was also added in the second year. Thalidomide (200 mg/day) was also given but withdrawn due to adverse effect after 10 days. Azathioprine was started at a dose of 100 mg/day following which there was resolution of symptoms by one week and no recurrences by 10 weeks; it was given for eight months after which the dose was tapered to 50 mg/day for another four months. Complete withdrawal of oral prednisolone after gradual tapering was possible by 12 months of azathioprine therapy. The patient is still on regular follow-up with no recurrences so far till the last check-up.</p>
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