{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T09:24:20Z","timestamp":1781774660843,"version":"3.54.5"},"reference-count":18,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,6,7]]},"abstract":"<jats:p>Erythema nodosum leprosum (ENL), also known as type II leprosy reaction, is a severe immune-mediated complication of multibacillary leprosy. For ENL, corticosteroids and thalidomide are the mainstays of treatment. Other immunosuppressants, such as clofazimine, cyclosporine, and azathioprine have also been used. Although most patients with ENL respond well to conventional treatments, a small number are refractory to these therapies and have severe morbidity or mortality. We report the case of a 24-year-old man with refractory ENL treated with high-dose corticosteroids for 15 months. The patient developed steroid-dependence and serious adverse effects, and died of an intracranial infection.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0118","type":"journal-article","created":{"date-parts":[[2017,3,27]],"date-time":"2017-03-27T19:44:46Z","timestamp":1490643886000},"page":"1362-1364","source":"Crossref","is-referenced-by-count":7,"title":["Therapeutic Dilemma of Refractory Erythema Nodosum Leprosum"],"prefix":"10.4269","volume":"96","author":[{"given":"Jianyu","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Leprosy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Degang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Therapy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Leprosy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhichun","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Leprosy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Wkly Epidemiol Rec","first-page":"389","article-title":"Global leprosy update, 2013; 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