PROLONGED USE OF MUL TIDRUG THERAPY FOR L EPROSY LEADING TO MULTIPLE COMPLICATIONS
Journal of Evidence Based Medicine and Healthcare
Multidrug therapy (MDT) for leprosy was recommended by WHO with a triple drug regimen of Dapsone, Rifampicin and Clofazimine, which is still the best treatment for leprosy. Side effects of these are commonly seen in clinical practice. Herein we present to you a case of 63 year old male patient who presented to the OPD with gastro-intestinal symptoms, paresthesias and difficulty in walking. It was only by proper history taking (he has been continuing MDT for the past 43 years), the diagnosis
... , the diagnosis could be made. Further workup revealed presence of methemoglobinemia, atrophic gastritis, peripheral neuropathy and subacute combined degeneration of spinal cord. Prompt treatment and withdrawal of the drug lead to improvement of the symptoms. INTRODUCTION: Dapsone (4,4'diaminophenyl sulfone) is the primary drug for Leprosy, 1 and is also often prescribed in the management of several inflammatory dermatoses like dermatitis herpetiformis, erythema elevatum diutinum, acne conglobata, bullous lesions in lupus erythematosus and infections like actinomycetoma, P. carinii pneumonia and Falciparum malaria. 2, 3 It is a potent anti -inflammatory and anti-parasite compound . Clofazimine (Lamprene/B663) is a prototype lipophilic riminophenazine antibiotic 4 which has both anti-mycobacterial and anti-inflammatory action. It has been primarily used in multibacillary leprosy as a component of WHO recommended triple drug regimen, since 1962. 5 Clofazimine accumulates in the skin and nerves because of its lipophilicity, while its antiinflammatory activities control harmful erythema nodosum leprosum and reverse immunity reactions, which may complicate antimicrobial chemotherapy. It is also used as a second line treatment along with other drugs for drug-resistant TB. WHO recommends clofazamine as Group 5 medicine. i.e an a agent with unclear efficacy, for use in patients with XDR TB. 6 Both the drugs have adverse effects if taken for a prolonged period of time. CASE REPORT: A 63 year old male patient presented to the outpatient department one day after he had one episode of hematemesis. He complained of difficulty in swallowing, loss of appetite due to persistent nausea and loss of weight (approx. 5kgs) since past 3 months which were progressively increasing. He had a history of difficulty in writing, buttoning the shirt, tingling and numbness in both the feet, inability to walk in narrow pathways and decrease in muscle mass since past 3 years which was progressively increasing in nature.