Thalidomide
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Ulnar neuritis: case report A 33-year-old man developed late-onset ulnar neuritis during treatment with thalidomide for erythema nodosum leprosum. The man, who had lepromatous leprosy, presented with numbness in the right hand, including fingers, and difficulty in writing. Four years prior to the current presentation, he had completed multidrug therapy (MDT) consisting of rifampicin [rifampin], clofazimine and dapsone. One year after therapy initiation, his treatment course had been complicated by development of numerous erythematous and tender lesions on bilateral legs and arms, consistent with erythema nodosum leprosum. He then started receiving thalidomide [route not stated] 100 mg/day along with MDT. Multiple attempts to discontinue thalidomide failed due to the recurrence of the lesions. One month prior to the current presentation, he had re-initiated thalidomide 100 mg/day following a 3-month thalidomide-free period. Nerve conduction studies of the right arm revealed right ulnar neuropathy at the elbow with focal demyelination and severe axonal loss. At the current presentation, a right elbow MRI showed focal area of ulnar nerve inflammation within the cubital fossa without mass effect. He was then diagnosed with ulnar neuritis [duration of treatment to reaction onset not stated]. The man was treated with a 5-week prednisone taper. The treatment with thalidomide was continued throughout the prednisone taper and one year after the prednisone taper. Three months following prednisone therapy, he did not show any difficulty in gross motor or activities of daily living, although he showed some residual difficulty in performing tasks with his right hand on instruments. One year after the completion of the prednisone taper, the right hand numbness and weakness resolved. Neurologic examination showed full range of motion, sensation and strength. Author comment: "Given this patient’s prolonged exposure to thalidomide treatment over several years, it also remains possible that his neuritis is secondary to adverse drug effect of thalidomide, as peripheral neuropathy has been described in patients undergoing thalidomide treatment for leprosy as well as multiple myeloma." Wellington T, et al. Late-onset ulnar neuritis following treatment of lepromatous leprosy infection. PLOS Neglected Tropical Diseases 13: No. 8, Aug 2019. Available from: URL: http://doi.org/10.1371/journal.pntd.0007684 803436647 USA
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Reactions 30 Nov 2019 No. 1781
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