A 68 year-old male presented with painful swelling in the extremities and disseminated small brownish nodules over his entire body. A histological examination of the skin nodules showed multiple granuloma and a thickened peripheral nerve bundle surrounded with foamy macrophages and a few lymphocytes. Fite stain revealed numerous acid fast bacilli within the cytoplasm of the foamy cells. A diagnosis of lepromatous leprosy was thus made and multi-drug therapy following the Japanese guideline with DDS, rifampicin and clofazimine was started. The clinical features improved, and the morphological index decreased after undergoing chemotherapy. Although a severe type 1 reaction developed after four months of treatment, he was treated with oral prednisolone at a dose of 40 mg/day.
