An unexpected case of venous and pulmonary thrombo-embolism in a patient treated with thalidomide for refractory erythema nodosum leprosum: a case report

The benefit of the immunomodulatory effects of thalidomide was discovered accidentally in 1965 when it was given to patients with leprosy as a sedative to relieve their suffering. Subsequently, researchers noticed an unexpected clinical improvement in the signs and symptoms of ENL. Since then, the off-label use of thalidomide has become increasingly popular due to its effectiveness in the treatment of a variety of malignant and non-malignant conditions refractory to other treatments. Although common adverse effects of thalidomide therapy are well-documented in literature since its introduction, some of the uncommon risks associated with its use are still being discovered. In the recent past, there has been an increased incidence of adverse events being reported in patients treated with thalidomide including thromboembolic complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE). Many studies have reported thomboembolic events with thalidomide when used in combination with multi-drug chemotherapy regimens for the treatment of multiple myeloma [1]. These thrombotic events have also been reported in non malignant conditions treated with thalidomide. A literature search shows few cases of DVT in patients treated with thalidomide for ENL and so far only two cases have been reported with concurrent DVT and pulmonary embolism. [2,3]A 60-year old man from Sri Lanka presented with a history of sudden onset breathlessness and right sided pleuritic chest pain. 5 days before he had developed a painful swelling of his right leg while he was being treated in the hospital for recurrent episodes of ENL. 3 years ago he was diagnosed to have lepromatous leprosy following a positive slit skin smear for mycobacterium leprae. He was commenced on World Health Organization (WHO) multi-drug therapy (MDT) regimen for multi-bacilary (MB) leprosy, which was complicated by type II lepra reaction (ENL) with right sided panuveitis and treated with oral prednisolone 30 mg/day