Clinical, therapeutic, and stigma-related challenges in leprosy and the emerging role of apremilast in managing leprosy reactions

Résumé fourni par la source

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae (or M. lepromatosis ) that targets macrophages and Schwann cells. The resulting neuropathy and skin lesions can lead to lifelong deformities and disabilities. Despite being poorly transmissible and readily treatable, leprosy remains a neglected disease. Management is hampered by delayed diagnosis, multidrug resistance, recalcitrant leprosy reactions, and entrenched social stigma. We report a case of imported multidrug-resistant borderline lepromatous leprosy that progressed with recurrent, steroid-dependent erythema nodosum leprosum (ENL). The patient experienced multiple toxicities secondary to the medications used for treating leprosy and managing ENL. Disease was controlled through a clofazimine–clarithromycin–minocycline regimen combined with the phosphodiesterase-4 inhibitor apremilast, enabling complete withdrawal of corticosteroids and thalidomide while maintaining sustained clinical and microbiological remission. We examine the key clinical challenges in managing this patient and summarise current evidence, including a literature review on apremilast as treatment for refractory leprosy reactions. • Leprosy is often diagnosed too late in non-endemic regions. • Late diagnosis leads to severe nerve and skin damage, causing permanent deformities and disabilities. • Treatment is standardised and accessible, but antibiotic resistance is increasing. • Recalcitrant leprosy reactions often complicate management long after therapy has ended. • Management of patients is hampered by entrenched social stigma.

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