20 yr old female with ERYTHEMA NODOSUM LEPROSUM (ENL)

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment

A 20 yr old female who is a student came with c/o. painful skin lesions over both UL & LL and trunk since 2 yrs (on -off),
H/o nodules on UL & LL with 
H/o fever + associated with joint pains, pedal edema , breathlessness 

The lesions initially started as erythematous papules and later progressed to hyperpigmented plaques within 3 days

K/c/o leprosy diagnosed in govt. hospital taken MB-MDT 11 months prior to onset of present skin lesions
Pt was video counselled for tab.thalidomide 100mg bd on 03/09/21 & on irregular follow up (multiple times & tapered on lesions subsiding on & off)
Slit skin smear done on 03/09/21:(report missed)
Slit skin smear done on 06/11/21: 
AFB--3+
BI--3
MI--60%
Advised to restart MB-MDT & tapered tab.thalidomide 50mg alternate day × 2 weeks 

No significant family history
No other comorbidities 


O/E: pt is c/c/c
Icterus+
No pallor,clubbing, cyanosis, genaralised Lymphadenopathy, pedal edema

Vitals: 
Temp:98.2F
Bp:100/70 mmhg 
Pr: 82bpm
Rr:18 cpm

Generalized xerosis with hyperpigmentation noted all over the body & face

Systemic examination:
Cvs: S1S2 heard
Rs:BAE+,NVBS heard
P/A: soft,non tender,bs+
Cns: NFD

Provisional diagnosis:
F/u/c  Erythema Nodosum Leprosum(ENL)

TREATMENT:
1.continue MB-MDT
2.Tab.THALIDOMIDE 50 mg alternate days


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