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Type 1 lepra reaction — DTM&H MCQ

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HardTropical bacterial infectionsType 1 lepra reactionDTM&H

Two months into multidrug therapy for borderline tuberculoid leprosy, existing plaques become swollen and an ulnar nerve becomes newly painful with weak finger abduction. What is the priority?

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Correct answer: E — Start systemic corticosteroid while continuing multidrug therapy

The best answer is “Start systemic corticosteroid while continuing multidrug therapy”. This is a type 1 reversal reaction with active neuritis and evolving motor deficit. Corticosteroid treatment is urgent to limit irreversible nerve injury, while leprosy multidrug therapy continues. Waiting for biopsy or stopping antimicrobial therapy delays nerve-saving treatment.

Reference: WHO: Leprosy fact sheet: https://www.who.int/news-room/fact-sheets/detail/leprosy