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Multicenter Study
. 2015 Sep 9;9(9):e0004065.
doi: 10.1371/journal.pntd.0004065. eCollection 2015.

ENLIST 1: An International Multi-centre Cross-sectional Study of the Clinical Features of Erythema Nodosum Leprosum

Stephen L Walker  1 , Marivic Balagon  2 , Joydeepa Darlong  3 , Shimelis N Doni  4 , Deanna A Hagge  5 , Vikas Halwai  6 , Annamma John  7 , Saba M Lambert  8 , Armi Maghanoy  2 , Jose A C Nery  9 , Kapil D Neupane  5 , Peter G Nicholls  10 , Vivek V Pai  6 , Pawan Parajuli  5 , Anna M Sales  9 , Euzenir Sarno  9 , Mahesh Shah  5 , Digafe Tsegaye  4 , Diana N J Lockwood  1 ; Erythema Nodosum Leprosum International STudy Group
Collaborators, Affiliations
Multicenter Study

ENLIST 1: An International Multi-centre Cross-sectional Study of the Clinical Features of Erythema Nodosum Leprosum

Stephen L Walker et al. PLoS Negl Trop Dis. .

Abstract

Erythema nodosum leprosum (ENL) is a severe multisystem immune mediated complication of borderline lepromatous leprosy and lepromatous leprosy. ENL is associated with skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. The treatment of ENL requires immunosuppression, which is often required for prolonged periods of time and may lead to serious adverse effects. ENL and its treatment is associated with increased mortality and economic hardship. Improved, evidence-based treatments for ENL are needed; however, defining the severity of ENL and outcome measures for treatment studies is difficult because of the multiple organ systems involved. A cross-sectional study was performed, by the members of the Erythema Nodosum Leprosum International STudy (ENLIST) Group, of patients with ENL attending seven leprosy referral centres in Brazil, Ethiopia, India, Nepal, the Philippines and the United Kingdom. We systematically documented the clinical features and type of ENL, its severity and the drugs used to treat it. Patients with chronic ENL were more likely to be assessed as having severe ENL. Pain, the most frequent symptom, assessed using a semi-quantitative scale was significantly worse in individuals with "severe" ENL. Our findings will determine the items to be included in a severity scale of ENL which we are developing and validating. The study also provides data on the clinical features of ENL, which can be incorporated into a definition of ENL and used for outcome measures in treatment studies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Location of pain in ENL.
Fig 2
Fig 2. Symptoms other than pain in ENL.
Fig 3
Fig 3. The degree of fever (temperature > 37.5°C) was not significantly different between groups with mild, moderate or severe ENL.
Fig 4
Fig 4. The frequency of the morphology of skin lesions in ENL (EM = erythema multiforme).
Fig 5
Fig 5. Number of skin lesions and severity of ENL.
Fig 6
Fig 6. Organ involvement in ENL.
Fig 7
Fig 7. Duration of ENL and presence of nerve function impairment (NFI).
See this image and copyright information in PMC

References

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