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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
In a report of 6 patients with Hansen's disease and coexistent COVID-19 treated at a hospital between April 2020 and October 2020, 3 men aged 30−32 years were described, who developed type I or type II lepra reaction during treatment with clofazimine, dapsone or rifampicin for Hansen's disease [routes not stated; not all dosages and times to reaction onsets stated].
The 31-year-old man (case 2), who had Gilbert's syndrome and Hansen's disease borderline-tuberculoid, had been receiving multidrug therapy with dapsone and rifampicin. However, he was intolerant (unspecified reaction) to dapsone, and he started receiving modified multidrug therapy with clofazimine 50mg daily and rifampicin 600mg once a month for Hansen's disease. He developed type I lepra reaction secondary to modified multidrug therapy with clofazimine and rifampicin. Therefore, he started receiving prednisolone 60mg daily for lepra reaction. Later, while he had been receiving prednisolone for past 2 months with dose tapered from 60mg daily to 20mg daily along with modified multidrug therapy , he was diagnosed with COVID-19. At the time of COVID-19 illness, he had persistent type I lepra reaction, without any change in severity, which indicated lack of efficacy of prednisolone. COVID-19 was uneventful, and he tested negative after 17 days.
The 32-year-old man (case 3), who had symptomatic Hansen's disease borderline-lepromatous with ulnar clawing of the right hand for 4 months, had been receiving multidrug therapy with dapsone and rifampicin for 8 weeks. He developed type I lepra reaction secondary to dapsone and rifampicin. He was treated with prednisolone, and multidrug therapy was continued. Later, he was diagnosed with COVID-19, while he had type I lepra reaction for 6 weeks. Prednisolone was tapered. the COVID-19 illness and recovery were uneventful. Two weeks later, he experienced exacerbation of the lepra reaction, which was considered to have been caused due to cytokine shift in COVID-19 over an extended course of time. Therefore, he again started receiving prednisolone at a higher dose (60mg daily). At the time of report, he was asymptomatic.
The 30-year-old man (case 5), who had Hansen's lepromatous-lepromatous disease for 3 years, had been receiving multidrug therapy with dapsone and rifampicin. However, he was intolerant (unspecified reaction) to dapsone, and he started receiving modified multidrug therapy with clofazimine 50mg daily and rifampicin 600mg once a month for Hansen's disease. At 5 months of treatment, he developed type II lepra reaction secondary to clofazimine and rifampicin. Therefore, he started receiving prednisolone, and multidrug therapy was continued. At 7 months of multidrug therapy, he was diagnosed with COVID-19 and microcytic hypochromic anaemia. He received off-label therapy with ascorbic-acid [Vitamin C] 500mg tablet once daily and zinc 50mg tablet once daily for COVID-19. Also, he received a single unit of packed erythrocytes [red blood cells]. He tested negative for COVID-19 after 35 days. During the immediate follow-up period, he experienced exacerbation of the lepra reaction, which was considered to have been caused due to cytokine shift in COVID-19 over an extended course of time. Also, he developed multiple furunculosis. For lepra reaction, he was treated with thalidomide, and prednisolone was stopped. He received amoxicillin [amoxicillin] and clavulanic acid for furunculosis. At the time of report, he was asymptomatic after being treated with multidrug therapy (dapsone and rifampicin) and thalidomide for 10 weeks.
Reference
- Arora S, et al. Hansen's disease in the era of COVID-19: An observation on a series of six patients with co-infection. Dermatologic Therapy 34: 1-4, No. 2, Mar-Apr 2021. Available from: URL: 10.1111/dth.14827 [DOI] [PMC free article] [PubMed]