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Post-LLETZ Follow-Up HIV — SCE Infectious Diseases MCQ

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HardHIV MedicinePost-LLETZ Follow-Up HIVSCE Infectious Diseases

Four weeks after starting MDT for borderline tuberculoid leprosy, a patient develops inflamed existing plaques, painful ulnar-nerve enlargement and new weakness of finger abduction. What is the priority management?

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Correct answer: C — Continue MDT and begin systemic corticosteroids with serial nerve-function assessment for a type-1 reaction

Explanation lettering: B = shown as A · A = shown as B

C is correct. Enlargement and tenderness of a previously involved nerve with rapid motor loss during treatment is a severe type-1 reversal reaction. The urgent aim is preservation of nerve function with systemic corticosteroids and repeated sensory and motor assessment; the planned MDT course continues. A unnecessarily interrupts effective antimicrobials. B mistakes inflammation for bacillary failure and adds toxicity without benefit. D undertreats new objective motor neuropathy with NSAIDs. E uses thalidomide, a treatment for selected type-2 erythema nodosum leprosum, not this cell-mediated reversal reaction. Surgical decompression is considered selectively, not as a substitute for immediate anti-inflammatory treatment.

Reference: WHO: management of leprosy reactions and prevention of disability: https://www.who.int/publications/i/item/9789290227595