A rare case of severe Bullous Erythema Nodosum Leprosum in histoid leprosy

Leprosy is a single disease with a spectrum of clinical manifestations. Histoid leprosy is rare and considered as a variant of lepromatous leprosy, characterized by shiny skin papules and nodules with or without other skin findings. Bacilli in histoid leprosy are longer and the Bacillary Index is generally 5+ to 6+. Treatment is generally extended to 24 months of multidrug therapy (MDT). Reactions are rare in histoid leprosy. Only a few case reports of Type I and erythema nodosum leprosum (ENL) reactions with histoid leprosy are available in the literature. Bullous ENL is another rare and atypical variant of ENL. The association of bullous ENL with histoid leprosy is extremely rare and no reports were found in the literature. We report a case of a known histoid leprosy patient who was on regular MDT for one year with good improvement in existing nodules and papules, and who presented with sudden onset bullous ENL reaction.