Question:medium
A patient who has been on MBMDT presents with inflammation over pre-existing lesions and nerve involvement. What will be the best approach of treatment?
A patient who has been on MBMDT presents with inflammation over pre-existing lesions and nerve involvement. What will be the best approach of treatment?
Show Hint
In lepra reactions, anti-leprosy treatment is never stopped; the reaction is managed by adding specific anti-inflammatory agents.
Updated On: Jun 23, 2026
- Stop ALT and start steroids
- Stop ALT and start thalidomide
- Continue ALT and start steroids
- Continue ALT and give thalidomide
Show Solution
The Correct Option is C
Solution and Explanation
Scenario: Patient on MBMDT (leprosy treatment) develops inflammation over existing skin lesions + nerve involvement.
Diagnosis: Type 1 Lepra Reaction (Reversal Reaction)
- Mechanism: Abrupt increase in cell-mediated immunity (CMI) against Mycobacterium leprae
- Features: Erythema, edema, warmth of pre-existing plaques; nerve tenderness; new ulcerations
- Most common in borderline leprosy subtypes (BT, BB, BL)
Golden rule in lepra reactions: ALT/MDT is NEVER stopped during a reaction -- stopping increases bacterial load.
Management of Type 1 reaction:
- Continue ALT (MDT)
- Add corticosteroids (prednisolone 40-60 mg/day, tapered over weeks)
- Steroids prevent irreversible nerve damage
Note on thalidomide: Thalidomide is used for Type 2 (ENL) reactions, not Type 1.
\[\boxed{\text{Continue ALT and start steroids}}\]
Diagnosis: Type 1 Lepra Reaction (Reversal Reaction)
- Mechanism: Abrupt increase in cell-mediated immunity (CMI) against Mycobacterium leprae
- Features: Erythema, edema, warmth of pre-existing plaques; nerve tenderness; new ulcerations
- Most common in borderline leprosy subtypes (BT, BB, BL)
Golden rule in lepra reactions: ALT/MDT is NEVER stopped during a reaction -- stopping increases bacterial load.
Management of Type 1 reaction:
- Continue ALT (MDT)
- Add corticosteroids (prednisolone 40-60 mg/day, tapered over weeks)
- Steroids prevent irreversible nerve damage
Note on thalidomide: Thalidomide is used for Type 2 (ENL) reactions, not Type 1.
\[\boxed{\text{Continue ALT and start steroids}}\]
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