01730nas a2200217   4500000000100000008004100001653001300042653002600055653001300081653001300094653002000107653003000127100001400157700001200171700001100183700001200194245012100206856006700327300001200394520110600406       2024                            d10aAtypical10aType 2 lepra reaction10aPustular10aNecrotic10aSweets Syndrome10aSuppurative Lymphadenitis1 aChauhan S1 aVerma G1 aNegi L1 aSingh A00aRare Presentation of Type 2 Lepra Reaction with Suppurative  Lymphadenitis and Pustular Sweets Syndrome-like Lesions  uhttps://www.ijl.org.in/published-articles/28122024074238/9.pdf  a331-3343 a<p>The unusual presentations of lepra reactions (LRs) or leprosy often warrant the exclusion of close mimickers especially if cardinal signs of leprosy are lacking. In such cases, demonstration of acid-fast bacilli (AFB) either on slit skin smear microscopy (SSS) or histopathology or on cytology can aid in early diagnosis of leprosy. Here a 72-year-old untreated case of leprosy is reported for atypical presentation of type 2 lepra reaction (T2LR) in the form of massively enlarged, generalized lymphadenitis with secondary suppuration in groin and axillary groups. The patient also had fever, constitutional symptoms, sweets syndrome-like tender plaques, and pustules over the extensors of the extremities. Despite having visible deformities in her hands for the past 10 years, the patient denied any treatment for leprosy. The demonstration of AFB on lymph node cytology and subsequently on repeated SSS from ears confirmed the diagnosis of leprosy. After that other clinical possibilities like sweets syndrome with underlying lymphoma or concomitant tubercular lymphadenitis were excluded.</p>