Chronic Erythema Nodosum Leprosum during the Treatment of Lepromatous Leprosy

Abstract

A male in his twenties from abroad was referred to us with a two-week history of right hand pain and a six-week history of multiple shiny nodules on his face, distal limbs, waist and abdomen. These nodules scored high on the skin smear tests, and histological examination revealed histiocyte granuloma with many bacilli. PCR test specific for Mycobacterium leprae was positive. These findings were consistent with the lepromatous type of leprosy. Erythema nodosum leprosum (ENL) appeared three weeks after he started the multi drug therapy, accompanied by various symptoms including neuritis, fever, and joint pain. ENL recurred and then became chronic afterwards. Leprosy and leprosy reactions can cause permanent damages if not treated properly. Early detection and treatment have minimized the sequelae in this case.