Case report: Cyclophosphamide pulse therapy for chronic recalcitrant erythema nodosum leprosum

Gustavo U Machado; Thiago Amparo; Flávia Bulhões; Paulo R L Machado

doi:10.3389/fmed.2023.1272404

Case report: Cyclophosphamide pulse therapy for chronic recalcitrant erythema nodosum leprosum

Front Med (Lausanne). 2023 Oct 25:10:1272404. doi: 10.3389/fmed.2023.1272404. eCollection 2023.

Authors

Gustavo U Machado¹, Thiago Amparo², Flávia Bulhões², Paulo R L Machado^{1

3}

Affiliations

¹ Serviço de Imunologia, Hospital Universitário Prof. Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.
² Serviço de Dermatologia, Hospital Universitário Prof. Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.
³ Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil.

Abstract

Chronic recalcitrant erythema nodosum leprosum (ENL) or type 2 reaction (T2R) is a severe condition found in approximately 50% of multibacillary leprosy subjects. T2R is associated with important morbidities and may lead to several disabilities, not only due to nerve damage but also due to the prolonged use of corticosteroids, thalidomide, or immunosuppressors. We describe here four leprosy patients with chronic recalcitrant ENL treated with cyclophosphamide pulse therapy. All subjects had been on prednisone and thalidomide therapy for at least 30 months but showed inflammatory activity when doses were reduced. Pulse therapy with 1.0 g of cyclophosphamide was used every 4-6 weeks for a minimum of three applications. After pulse therapy, all cases presented total or partial regression of symptoms, and we were able to taper thalidomide and prednisone doses, with better control of ENL, avoiding further hospital admissions and disabilities. No side effects were observed during or after infusion therapy. Cyclophosphamide pulse therapy may be useful and safe to control chronic recalcitrant ENL.

Keywords: cyclophosphamide; erythema nodosum leprosum (ENL); leprosy; pulse therapy; type 2 reaction.

Publication types

Case Reports

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT).