The association of pregnancy and leprosy. III. Erythema nodosum leprosum in pregnancy and lactation

Abstract

Seventy-six women with lepromatous leprosy were studied during 79 pregnancies and followed up during lactation for up to 24 months. Ten out of 45 BL patients (22%) and 20 out of 34 LL patients (59%) developed erythema nodosum leprosum (ENL) during the course of the study. Only 4 out of 30 patients were BI negative, although the duration of effective treatment for leprosy ranged from 1 to 14 years. Thirteen of the 30 ENL patients were suspected of developing dapsone resistance during the study period. The incidence of ENL was highest in the first trimestre with a second peak in the third trimestre, coinciding with the peak of relapse. Fifteen per cent of the women suffered from ENL almost continuously from the third trimestre to 15 months postpartum. In pregnancy ENL was seen more frequently in skin than in nerve or other tissue; however, after delivery, particularly in the recurrent or persistent episodes, ENL was seen more commonly in nerve than in skin. Significant sensory and/or motor loss occurred in 30 out of 38 episodes of ENL nerve involvement. The significance of these findings is discussed.