Clofazimine-induced enteropathy in a patient of leprosy
A 19-year-old tribal male patient was diagnosed with multibacillary leprosy, for which he was taking MDT for the last 8 months. He was under regular follow-up in the Department of Dermatology at Government Medical College, Jagdalpur, Chhattisgarh. He presented with 1 week history of abdominal pain which was described as periumbilical, dull-aching pain without any referred pain. The pain was recently aggravating, dull-aching, intermittent, lasting for hours, tended to occur during the night, not related to food intake and was not relieved by prescribing a proton pump inhibitor or antacid.\nPatient was then referred to surgical unit, where physical findings revealed few enlarged lymph nodes at the left cervical region and mild tenderness at the umbilical region without guarding or stiffness. No hepatosplenomegaly or enlargements of the superficial nerve were detected. Abnormal laboratory findings included eosinophilia, hypoalbuminemia, and mild hyperglobulinemia. The serology test for human immunodeficiency virus (HIV) infection and syphilis were negative.\nTo exclude peptic ulcer disease, urease test and microscopic examination of gastric mucosa was done. The lymph node biopsy failed to demonstrate malignant lymphoma. Endoscopic biopsies of the stomach, duodenum, as well as jejunum were performed. Mild, chronic inflammation of the gastric and duodenal mucosa was observed. Few crystal-storing (red colored) histiocyte was detected in the lamina propria of the duodenum, but several crystal-storing histiocyte were observed in the lamina propria of the jejunum [].\nThe patient's illness history revealed that he had lepra-2 reaction [Erythema NodosumLeprosum (ENL)] during MDT course for which he was prescribed clofazimine in high dose; that is 100 mg thrice a day for 1 month; later 100 mg twice a day for next 15 days with additional appropriate corticosteroid and then regular MDT treatment was continued. The reaction subsided without any adverse events at that time.\nAfter a brief text search, it was concluded that these crystals represented clofazimine crystals, and the afore mentioned clinical, radiographic, and pathologic descriptions were characteristic of clofazimineenteropathy.[–]\nAll clinical and lab data indicated that clofazimine was the reason for sudden onset of pain abdomen. The offending drug was stopped with appropriate alternative regimens. The patient improved slowly over about 2 months of follow-up. He still had intermittent abdominal pain that was relieved by analgesics.