{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T10:23:43Z","timestamp":1787394223223,"version":"build-2736575974"},"reference-count":8,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Introduction.\u00a0Chronic erythema nodosum leprosum (ENL) is a challenging complication of Hansen\u2019s disease (HD), with limited treatment options and frequent steroid dependence. Anti-tumour necrosis factor (TNF)-\u03b1 agents are promising alternatives, though evidence remains confined to a few reports.<\/jats:p>\n                  <jats:p>Case description.\u00a0We report the case of a 34-year-old Moroccan man with multibacillary Hansen\u2019s disease, who developed chronic ENL with recurrent systemic and cutaneous flares, requiring prolonged immunomodulatory therapy. Corticosteroids, thalidomide, azathioprine, methotrexate, and anti-TNF-\u03b1 therapy only provided incomplete control. After six years of recurrences requiring several hospitalizations, treatment with methylprednisolone, high-dose thalidomide, and clofazimine achieved a sustained remission, allowing gradual treatment discontinuation.<\/jats:p>","DOI":"10.1093\/trstmh\/trag091","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:03:31Z","timestamp":1785585811000},"source":"Crossref","is-referenced-by-count":0,"title":["Chronic erythema nodosum leprosum in Hansen\u2019s disease: a challenging clinical management"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5377-7118","authenticated-orcid":false,"given":"Michele","family":"Spinicci","sequence":"first","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]},{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4152-9346","authenticated-orcid":false,"given":"Anna","family":"Barbiero","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Manciulli","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costanza","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Fedi","sequence":"additional","affiliation":[{"name":"Internal Medicine D Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bussotti","sequence":"additional","affiliation":[{"name":"Casa Stenone, Fondazione Solidarit\u00e0 Caritas ETS , Via di Pulicciano 77, 50012 Bagno a Ripoli ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Silvestri","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]},{"name":"Internal and Specialistic Medicine Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Malandrino","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]},{"name":"Internal and Specialistic Medicine Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Emmi","sequence":"additional","affiliation":[{"name":"Clinical Medicine and Rheumatology Unit, Cattinara University Hospital , Strada di Fiume 447, 34149 Trieste ,","place":["Italy"]},{"name":"Department of Medical, Surgery and Health Sciences, University of Trieste , Strada di Fiume 447, 34149 Trieste ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Gazzoli","sequence":"additional","affiliation":[{"name":"Medical & Scientific Department, AIFO ETS , Via Girolamo Borselli 4-6, 40135 Bologna ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0892-8404","authenticated-orcid":false,"given":"Lorenzo","family":"Zammarchi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]},{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9758-1523","authenticated-orcid":false,"given":"Alessandro","family":"Bartoloni","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]},{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"2026082205323406600_bib1","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1093\/trstmh\/traf058","article-title":"Decoding leprosy: immune response, clinical manifestations and emerging diagnostic approaches","volume":"119","author":"Serrano-Coll","year":"2025","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2026082205323406600_bib2","volume-title":"Leprosy\/Hansen Disease: Management of Reactions and Prevention of Disabilities","author":"World Health Organization","year":"2020"},{"key":"2026082205323406600_bib3","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1093\/trstmh\/traf097","article-title":"Unusual sequential type I and II reactions in lepromatous leprosy: a case report","volume":"120","author":"Qi","year":"2026","journal-title":"Trans R Soc Trop Med 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