Lepromatous Leprosy with Rare Presentation of Erythema Nodosum Leprosum: Enigma of Relapse versus Reinfection

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It can be a great imitator with varied manifestations, which unless identified and treated appropriately in a timely manner can lead to significant disabilities and deformities associated with profound psychological and social stigma. Vasculitis‑like lesions in leprosy are seen in type 2 lepra reactions (erythema nodosum leprosum [ENL]), Lucio phenomenon, and Lazarine leprosy. Here, we report a patient who presented with palpable purpura‑like and lichenoid lesions. On extensive enquiry of his history with correlation of clinical features and histopathology, he was diagnosed as lepromatous leprosy (? relapse or? reinfection or? persistent infection) with ENL. He was started on hepatosafe regimen, in view of his deranged liver and renal function tests. This form of presentation is rarely reported in the literature.