PRETERM

LABOR AS SIDE EFFECT OF METHYLPREDNISOLONE TREATMENT IN MORBUS HANSEN

PATIENT WITH PREGNANCY
Afifa, Nadhira Nuraini* Trianda, Fachreza* Prasetyo, Amanda Cyko*

Problem statement:
Morbus Hansen, or leprosy, is a chronic granulomatous infection that mainly attacks the skin and
peripheral nerves. It is caused by Mycobacterium leprae. Leprosy on women has been a complex health
problem because of some physiological changes of women such as hormonal changes, pregnancy,
lactation, and so on.
On January 31, 2013, a 26-year-old female was admitted to Dermatovenerology Department of Cipto
Mangunkusumo Hospital for BTA examination. When admitted, patient was having her first pregnancy
at 2 months. Patient was diagnosed with borderline lepromatous Morbus Hansen with reversal reaction
and erythema nodosum leprosum while pregnant. Patients primary complaints were fever, red bump
on upper and lower limbs, sore, and rash on face since a week after taking her second MDT MB (multi-
drug therapy multi-basilar).
Physical examination of face, abdomen, proximal left upper extremity, bilateral upper, and lower
extremity dermatological status showed erythematous plaque to hyperpigmentation, multiple discrete,
lenticular-placate sized, clear border and half-diffuse, warm, and hypestation. Bilateral upper and lower
extremity showed lenticular-numular sized erythematous plaque. A dilatation of right ulnar nerve was
also found. BTA examination showed bacterial index of 10/6 and morphological index of 0%.
At first, the patient was prescribed 4 mg 1x6 pills of methylprednisolone per day for two weeks before
the dose was lowered. Every time the methylprednisolone dose is lowered to 4 mg 1x4 pills per day, a
new bump appears accompanied by soreness, and methylprednisolone dose is then returned to normal.
Methylprednisolone is one of corticosteroid drugs which has certain effects on patient. Some literature
explained that increased risk of preterm labor and low birth weight is associated with chronic intake of
oral corticosteroid such as prednisolone or prednisone.
On August 13, 2013, the patient conceived a boy at 34 weeks of gestation. His weight is 2,370 grams and
the height is 18.5 inch. The patients methylprednisolone therapy is still continued.

Any history of hypertension, diabetes mellitus, heart anomalies, and lung anomalies, as preterm labor
risk factors were denied. Other risk factors such as smoking, caffeine consumption, low nutrition status,
and history of previous premature birth were also denied.
Methods:
Case report of a patient with borderline lepromatous morbus Hansen with reversal reaction and
erythema nodosum leprosum while pregnant.
Results:
It is impressed that the preterm labor and low birth weight of patient's baby can be associated with the
long-term use of methylprednisolone in pregnancy, although the use of dapsone which can lead to
anemia needs to be considered as well.
Conclusion:
Administration of corticosteroids for Morbus Hansen patient with pregnancy may indirectly affect fetal
development. Research on this topic is recommended.