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Area of Science:

  • Immunology
  • Infectious Diseases
  • Dermatology

Background:

  • Tumor necrosis factor (TNF)-α inhibitors are known to increase tuberculosis risk.
  • The impact of biologics on leprosy susceptibility and treatment remains largely undescribed.
  • Erythema nodosum leprosum (ENL) is a complication of leprosy that may benefit from biologic therapy.

Observation:

  • A systematic review identified 10 cases of leprosy diagnosed after initiating TNF-α inhibitors.
  • Four case reports and one unpublished case demonstrated successful treatment of refractory ENL with infliximab or etanercept.
  • Leprosy can manifest with skin lesions and arthritis, mimicking other conditions.

Findings:

  • TNF-α inhibitor use appears to be a risk factor for leprosy development or reactivation.
  • Biologics, specifically TNF-α inhibitors, may be effective in managing severe or refractory ENL.
  • Early consideration of leprosy is crucial in patients presenting with relevant symptoms before or during biologic therapy.

Implications:

  • Clinicians should consider leprosy in patients on TNF-α inhibitors who develop skin eruptions, arthritis, or neurological symptoms.
  • Leprosy diagnosis should be considered in patients presenting with suggestive signs prior to initiating TNF-α inhibitor therapy.
  • Further research is warranted to elucidate the precise relationship between TNF-α inhibitors and leprosy, and to optimize biologic use in ENL management.