Deep Vein Thrombosis in Refractory Erythema Nodosum Leprosum: A Report of Two Cases

Hansen's disease is a chronic granulomatous disease caused by Mycobacterium leprae. Acute exacerbations termed as lepra reactions often mark the course of the disease. These are of two types - Type 1 or Reversal Reaction and Type 2 or Erythema Nodosum Leprosum (ENL). Chronic recurrent ENL is a frequently encountered, difficult to treat condition which is usually managed with systemic corticosteroids, increasing the dose of clofazimine, non-steroidal anti-inflammatory drugs, cyclosporine A, azathioprine, pentoxyphylline, mycophenolate mofetil, methotrexate and intravenous immunoglobulin (IVIG). Thalidomide is the drug of choice in most instances. Thrombo-embolism is a rare but known complication of thalidomide therapy especially when combined with corticosteroids or chemotherapeutic agents. Herein we report 2 cases of refractory ENL developing Deep Vein Thrombosis (DVT) while on concomitant therapy with thalidomide and corticosteroids for the control of ENL.