Necrotic erythema nodosum leprosum – A case of severe lepromatous reaction in a multibacillary leprosy patient

Necrotic erythema nodosum leprosum (ENL) is an uncommon and severe complication of multibacillary leprosy, characterized by intense systemic inflammation, ulcerative lesions, and significant morbidity. This case report describes a 32-year-old male presenting with recurrent type 2 lepra reactions and necrotic lesions exacerbated by inconsistent adherence to multidrug therapy (MDT). The patient’s management involved MDT, corticosteroids, thalidomide, and hydroxychloroquine, which led to a substantial clinical improvement. Emerging evidence and a multidisciplinary approach have been used to address this complex pathophysiology and clinical presentation. This report demonstrates the necessity for uninterrupted treatment, early recognition, and tailored therapeutic interventions for managing severe lepra reactions.