[Persistent type 2 lepra reaction (erythema nodosum) and clofazimine-induced lethal enteropathy]. / Eritema nudoso leproso persistente y enteropatía letal por clofazimina.

INTRODUCTION: Clofazimine enterophathy is a serious complication of clofazimine when used at high doses for treatment of type 2 lepra or or erythema nodosum leprosum. Objective. A woman is presented who had a delayed diagnosis of leprosy, persistent type 2 lepra reaction and lethal clofazimine enteropathy. MATERIALS AND METHODS: A 31-year-old woman presented leprosy symptoms over a 16-year period without medical diagnosis of her disease. During this period, type 2 lepra episodes occurred, but were not accurately diagnosed. These episodes became more severe during her second pregnancy. The patient and her family were interviewed, and her clinical history reviewed. RESULTS: After twelve years of medical consults, lepromatous leprosy was diagnosed, based on perforation of her nasal septum, with a bacterial index of 5. Her husband and a 12-year-old daughter have leprosy symptoms. During multidrug therapy, she presented with repeated type 2 lepra reaction episodes for which she received daily clofazimine 400 mg doses. Two months after this treatment, severe and frequent episodes of intense abdominal pain began to occur. These persisted for more than a year and were managed with in-hospital administration of several classes of painkillers and antispasmodic medication, including morphine. She also presented with sporadic diarrhea, constipation, nausea, weight loss and mesenteric adenopathies. She died finally due to this intestinal condition. No autopsy was performed. CONCLUSIONS: The patient's clinical presentation suggested a clofazimine-induced lethal enteropathy, a complication not previously seen in Colombia. This connection was not recognized by the medical officers that treated the patient.

Clofazimine enteropathy: possible relation to Peyer's patches.

Clofazimine administered orally to rats and mice caused pigmentation of the intestines, draining lymph nodes, fat, and other tissues and organs. Peyer's patches were always more deeply colored than the remainder of the intestine. A microscopic study revealed crystal-containing epithelioid cell granulomas in the patches and in the draining mesenteric lymph nodes but not in the remainder of the gut. During the evolution of the granulomas, some of the epithelioid cells were capable of phagocytosing an iron complex, a circumstance which made it possible to get detailed views of the clofazimine crystals in paraffin sections by negative contrast in histochemical stains for iron. The granulomas appeared after three oral treatments during 1 week, but were better developed after six or more treatments during 2 or more weeks. Similar observations were made in three strains of rats and in mice. We hypothesize that the greater pigmentation of Peyer's patches and their granulomatous response to clofazimine might indicate a special susceptibility to toxic effects of the drug. Whether or not this susceptibility is the starting point for an enteropathy can only be determined by examination of affected human tissues and by further animal experimentation.

[Small intestine transit anomalies in a patient with chronic abdominal pain and treated for Hansen's disease]. / Anomalies du transit du grêle chez une patiente présentant des douleurs abdominales chroniques et traitée pour une maladie de Hansen.

This new case of enteropathy due to Clofazimine provided demonstration of the diagnostic value of small bowel follow-through examination in this complication. Various small intestine anomalies have been reported: ileal or partial jejunal lesions; variations in caliber; loss of physiologic folds; irregularly outlined surface and border lacunae and persistence of suppleness of pathologic loops. Knowledge of these anomalies should avoid exploratory laparotomy, Clofazimine-induced enteropathy regressing after discontinuation of treatment. Repeat small bowel follow up examinations can be performed to review course of this regression.

[Enteropathy caused by clofazimine]. / Entéropathie à la clofazimine.

A case of Clofazimine enteropathy is reported, diagnosed on the demonstration of red brown birefringent crystals in the small bowel mucosa and submucosa as well as in the mesenteric lymph nodes whereas the clinical and radiological signs appear to be non specific. After the withdrawal of the drug, a clear improvement of the symptoms was achieved only under a gluten free diet. The possibility of such accidents, sometimes lethal, suggests the restriction of clofazimine to leprosy.

Small bowel deposition of crystals associated with the use of clofazimine (Lamprene) in the treatment of prurigo nodularis.

A 46-year-old woman with widespread prurigo nodularis was treated with 300 mg clofazimine a day for six months. Ten months after stopping the drug she complained of weight loss and gastrointestinal side effects which were shortly improved by a gluten-free diet, but relapsed one year later. At laparotomy, all tissues were stained bright orange-yellow, and histological examination showed crystals deposited in the chorion of intestinal villi and in the mesenteric lymph nodes.

[Exudative enteropathy caused by clofazimine: apropos of a case]. / Entéropathie exsudative à la clofazimine: à propos d'une observation.

The authors report a case of a forty-six year old woman suffering from generalized prurigo nodularis. This dermatosis was associated with a cellular immunodeficiency; therefore a clofazimine therapy 300 mg/a day was instituted for six months. Ten months after the cessation of the clofazimine therapy, there appeared a malabsorption syndrome that was temporarily improved by gluten--free diet the real etiology was only ascertained during laparotomy, when masses of crystals in the small intestine mucosa as well as in mesenteric lymph nodes were observed. Therefore when it is necessary to prescribe clofazimine to take advantage of become its immunoregulating properties, it must always become in mind that an intestinal complication may ensue: this is well recognized in articles appearing in journals devoted to leprosy.