The mortality associated with erythema nodosum leprosum in Ethiopia: a retrospective hospital-based study

PLoS Negl Trop Dis. 2014 Mar 13;8(3):e2690. doi: 10.1371/journal.pntd.0002690. eCollection 2014 Mar.


Background: Erythema nodosum leprosum (ENL) is a debilitating multisystem disorder which complicates leprosy. It is characterised by fever, malaise and painful erythematous cutaneous nodules. ENL is often recurrent or chronic in nature and frequently severe. Patients often require prolonged treatment with high doses of oral corticosteroids. There are no data on the mortality associated with treated ENL.

Methodology: The notes of patients who were admitted, discharged, transferred to another facility or died with a diagnosis of leprosy or a leprosy-related complication for a five year period were reviewed.

Result/discussion: 414 individuals were identified from the ward database. 312 (75.4%) patient records were located and reviewed. Ninety-nine individuals had ENL and 145 had a Type 1 reaction. The median age of individuals with ENLwas 25 years. Eight patients with erythema nodosum leprosum died compared with two diagnosed with Type 1 reaction. This difference is statistically significant (p = 0.0168, Fisher's Exact Test). There is a significant mortality and morbidity associated with ENL in this Ethiopian cohort. The adverse outcomes seen are largely attributable to the chronic administration of oral corticosteroids used to control the inflammatory and debilitating symptoms of the condition.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Child
  • Erythema Nodosum / drug therapy
  • Erythema Nodosum / epidemiology
  • Erythema Nodosum / mortality*
  • Ethiopia / epidemiology
  • Female
  • Hospitals
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Leprosy, Lepromatous / drug therapy
  • Leprosy, Lepromatous / epidemiology
  • Leprosy, Lepromatous / mortality*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Young Adult


  • Adrenal Cortex Hormones
  • Immunosuppressive Agents

Grant support

SLW received a small grant from the Royal Society of Tropical Medicine and Hygiene ( and is supported in part by the Hospital and Homes of St. Giles. SML is supported by the Hospital and Homes of St. Giles. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.