Erythema nodosum leprosum in a patient with lepromatous leprosy: A case report

Rationale: Lepromatous leprosy is a skin condition. Erythema nodosum leprosum (ENL) aids in its diagnosis. ENL is a type- 2 immune response, whereas lepra ENL is characterized by a hypersensitivity reaction and an exaggerated immune response through a different pathway.

Patient's Concern: A 40-year-old male patient, previously diagnosed with lepromatous leprosy, displayed painful skin lesions on his extremities.

Diagnosis: Type-2 lepra reaction, specifically erythema nodosum leprosum.

Interventions: The patient was initially treated with 100 mg dapsone daily and then with fusidic acid, prednisone, and other MDT agents, after development of dapsone resisitance. After type- 2 lepra reaction was lessened in just two weeks, the regimen was adjusted to prednisolone (up to 2 g daily), thalidomide (300 mg daily), minocycline (1.5 g daily), ofloxacin (1 g twice daily), and pentoxifylline (400 mg three times daily) over a six-month period.

Outcomes: The treatment effectively reduced the type-2 lepra reaction and improved the patient's skin lesions and overall health.

Lessons: Healthcare providers should maintain a high level of awareness regarding the symptoms and medical history associated with ENL to facilitate timely diagnosis and appropriate management strategies. It is critical to tailor treatment to each patient’s symptoms and responses for successful management. Consistent monitoring of inflammatory markers and regular follow-up appointments play vital roles in preventing complications and ensuring positive outcomes for patients with ENL.