Treatment of severe refractory erythema nodosum leprosum with tumor necrosis factor inhibitor Etanercept

“…The successful use of the anti-TNF therapy with infliximab and etanercept in three patients with ENL, resulting reduction of inflammation and treatment of ENL, is additional evidence of the inflammatory role of TNF-α in ENL (158–160). …”

Section: What Is the Role Of Tnf-α Or Other Cytokines In Enl?mentioning

confidence: 93%

A Systematic Review of Immunological Studies of Erythema Nodosum Leprosum

2017

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Erythema nodosum leprosum (ENL) is a painful inflammatory complication of leprosy occurring in 50% of lepromatous leprosy patients and 5–10% of borderline lepromatous patients. It is a significant cause of economic hardship, morbidity and mortality in leprosy patients. Our understanding of the causes of ENL is limited. We performed a systematic review of the published literature and critically evaluated the evidence for the role of neutrophils, immune complexes (ICs), T-cells, cytokines, and other immunological factors that could contribute to the development of ENL. Searches of the literature were performed in PubMed. Studies, independent of published date, using samples from patients with ENL were included. The search revealed more than 20,000 articles of which 146 eligible studies were included in this systematic review. The studies demonstrate that ENL may be associated with a neutrophilic infiltrate, but it is not clear whether it is an IC-mediated process or that the presence of ICs is an epiphenomenon. Increased levels of tumor necrosis factor-α and other pro-inflammatory cytokines support the role of this cytokine in the inflammatory phase of ENL but not necessarily the initiation. T-cell subsets appear to be important in ENL since multiple studies report an increased CD4+/CD8+ ratio in both skin and peripheral blood of patients with ENL. Microarray data have identified new molecules and whole pathophysiological pathways associated with ENL and provides new insights into the pathogenesis of ENL. Studies of ENL are often difficult to compare due to a lack of case definitions, treatment status, and timing of sampling as well as the use of different laboratory techniques. A standardized approach to some of these issues would be useful. ENL appears to be a complex interaction of various aspects of the immune system. Rigorous clinical descriptions of well-defined cohorts of patients and a systems biology approach using available technologies such as genomics, epigenomics, transcriptomics, and proteomics could yield greater understanding of the condition.

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“…In a study that compares the efficacy of clofazimine and pentoxifylline, pentoxifylline effectively reduced the initial severity, while clofazimine showed a slow but sustained effect [94]. Resistant erythema nodosum leprosum cases that treated successfully with methotrexate, infliximab and etanercept have been reported [95][96][97].…”

Section: Type 2 Reactionmentioning

confidence: 99%

An Update on the Epidemiology, Diagnosis and Treatment of Leprosy

Akpolat¹,

Akkus²,

Kaynak³

2019

Hansen's Disease - The Forgotten and Neglected Disease

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Leprosy is a granulomatous, chronic infection caused by Mycobacterium leprae that has been reported for than 2000 years. The infection primarily affects the skin and peripheral nerves.M. leprae is bacterium that cannot be cultured in vitro and transmission and pathophysiological data is still uncertain and limited. Today the prevalence of this ancient disease is declining in most around the world. This decline is a direct effect of widespread administration by public health workers of multidrug therapy. However, emerging despite the use of multidrug therapy, identifying and monitoring resistance are still necessary.

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Treatment of severe refractory erythema nodosum leprosum with tumor necrosis factor inhibitor Etanercept

Cited by 18 publications

References 6 publications

What is new in the pathogenesis and management of erythema nodosum leprosum

What is new in the pathogenesis and management of erythema nodosum leprosum

A Systematic Review of Immunological Studies of Erythema Nodosum Leprosum

An Update on the Epidemiology, Diagnosis and Treatment of Leprosy

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