The mortality associated with erythema nodosum leprosum in Ethiopia: a retrospective hospital-based study

Stephen L Walker, Eglantine Lebas, Shimelis N Doni, Diana N J Lockwood, Saba M Lambert, Stephen L Walker, Eglantine Lebas, Shimelis N Doni, Diana N J Lockwood, Saba M Lambert

Abstract

Background: Erythema nodosum leprosum (ENL) is a debilitating multisystem disorder which complicates leprosy. It is characterised by fever, malaise and painful erythematous cutaneous nodules. ENL is often recurrent or chronic in nature and frequently severe. Patients often require prolonged treatment with high doses of oral corticosteroids. There are no data on the mortality associated with treated ENL.

Methodology: The notes of patients who were admitted, discharged, transferred to another facility or died with a diagnosis of leprosy or a leprosy-related complication for a five year period were reviewed.

Result/discussion: 414 individuals were identified from the ward database. 312 (75.4%) patient records were located and reviewed. Ninety-nine individuals had ENL and 145 had a Type 1 reaction. The median age of individuals with ENLwas 25 years. Eight patients with erythema nodosum leprosum died compared with two diagnosed with Type 1 reaction. This difference is statistically significant (p = 0.0168, Fisher's Exact Test). There is a significant mortality and morbidity associated with ENL in this Ethiopian cohort. The adverse outcomes seen are largely attributable to the chronic administration of oral corticosteroids used to control the inflammatory and debilitating symptoms of the condition.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. (A) Number of patients with…
Figure 1. (A) Number of patients with different type of ENL skin lesions.
(B) Number of patients with different extra-cutaneous manifestations of ENL.
Figure 2. Duration of ENL.
Figure 2. Duration of ENL.
Figure 3. Co-morbidity associated with ENL.
Figure 3. Co-morbidity associated with ENL.
Figure 4. The proportion of individuals with…
Figure 4. The proportion of individuals with a co-morbidity and the number of episodes of ENL.

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