From the Research
Lepromatous leprosy and hemophagocytic lymphohistiocytosis (HLH) can occur together, with leprosy potentially triggering HLH as a secondary complication, and patients should be treated with multidrug therapy (MDT) consisting of rifampin, moxifloxacin, and minocycline (RMM) for 12-24 months, as this regimen has shown improved safety and efficacy in recent studies 1. The treatment of lepromatous leprosy involves the use of multidrug therapy to effectively eliminate Mycobacterium leprae and prevent resistance.
- The most recent and highest quality study recommends the use of monthly rifampin, moxifloxacin, and minocycline (RMM) for 12-24 months 1.
- This regimen has been shown to be effective in treating multibacillary leprosy, including patients with type-2 reactions, and pure neural leprosy with reversal reactions.
- The RMM regimen has been found to be well-tolerated, with no significant side effects or skin hyperpigmentation, and has improved treatment adherence compared to traditional MDT regimens. If HLH is suspected, immediate treatment with HLH-directed therapy is necessary, typically including dexamethasone, etoposide, and cyclosporine.
- Leprosy reactions, particularly erythema nodosum leprosum, may mimic HLH and require additional treatment with prednisone or thalidomide.
- Close monitoring of both conditions is essential, as leprosy treatment may need to continue for extended periods while HLH requires aggressive intervention to prevent mortality. The connection between lepromatous leprosy and HLH involves immune dysregulation, with Mycobacterium leprae triggering excessive cytokine production that can precipitate the hyperinflammatory state characteristic of HLH.
- The use of RMM regimen in the treatment of lepromatous leprosy has been found to be effective in reducing the risk of HLH and other complications associated with traditional MDT regimens 1.