Gunawan Hendra, Faldian Yogi, Hindritiani Reti
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia.
Int Med Case Rep J. 2022 May 31;15:263-268. doi: 10.2147/IMCRJ.S368213. eCollection 2022.
Pustular erythema nodosum leprosum (ENL) is an atypical manifestation associated with chronic ENL. The use of corticosteroid alone might not be sufficient for this condition, and addition of another anti-inflammatory drug is often necessary. Minocycline is a tetracycline antibiotic with anti-neutrophilic properties, which may accelerate the treatment of pustular ENL. This case report aimed to elaborate on the beneficial effect of minocycline for pustular ENL.
We report a case of pustular ENL in a 23-year-old male who had been released from treatment (RFT) of lepromatous leprosy (LL). The patient had been on prednisone for six months as treatment for ENL. The condition recurred when prednisone was tapered to 10 mg daily. Eventually, pustules developed on the erythematous nodules, and the lesions did not improve despite seven weeks of treatment with 40-60 mg prednisone. Later, 100 mg minocycline once daily was given in addition to 60 mg prednisone once daily and improvement was rapidly observed on the ninth day after minocycline administration. This condition was sustained for four weeks with prednisone tapering, and no side effects were reported during the treatment.
Minocycline is an antibiotic with anti-inflammatory properties. Only a few studies have been conducted regarding the use of minocycline in chronic ENL, but there was no reported case of minocycline use for pustular ENL in RFT patient. The addition of minocycline to prednisone may accelerate the improvement of pustular ENL. We observed an improvement after the ninth day of minocycline administration compared to seven weeks of prednisone monotherapy. No new ENL lesions occurred during four weeks of minocycline administration therapy.
Pustular ENL is an atypical manifestation of chronic ENL, and the addition of minocycline to prednisone may accelerate its therapeutic effect on the patient.
脓疱型结节性红斑麻风（ENL）是一种与慢性ENL相关的非典型表现。单独使用皮质类固醇可能不足以治疗这种疾病，通常需要加用另一种抗炎药物。米诺环素是一种具有抗中性粒细胞特性的四环素类抗生素，可能会加速脓疱型ENL的治疗。本病例报告旨在阐述米诺环素对脓疱型ENL的有益作用。
我们报告一例23岁男性脓疱型ENL病例，该患者已完成瘤型麻风（LL）治疗。患者接受泼尼松治疗ENL已六个月。当泼尼松减至每日10 mg时病情复发。最终，红斑结节上出现脓疱，尽管使用40 - 60 mg泼尼松治疗七周，病情仍未改善。后来，除每日一次60 mg泼尼松外，加用每日一次100 mg米诺环素，在服用米诺环素九天后迅速观察到病情改善。随着泼尼松逐渐减量，这种情况持续了四周，治疗期间未报告有副作用。
米诺环素是一种具有抗炎特性的抗生素。关于米诺环素在慢性ENL中的应用仅有少数研究，但尚无关于在已完成治疗的患者中使用米诺环素治疗脓疱型ENL的报告病例。在泼尼松基础上加用米诺环素可能会加速脓疱型ENL的改善。与泼尼松单药治疗七周相比，我们观察到在服用米诺环素九天后病情有所改善。在米诺环素给药治疗的四周内未出现新的ENL病变。
脓疱型ENL是慢性ENL的非典型表现，在泼尼松基础上加用米诺环素可能会加速其对患者的治疗效果。
