Severe Type 2 leprosy reaction with COVID-19 with a favourable outcome despite continued use of corticosteroids and methotrexate and a hypothesis on the possible immunological consequences.

Type 2 leprosy reaction(T2LR) or Erythema Nodosum Leprosum (ENL) often poses a therapeutic challenge to clinicians and commonly requires long courses of steroids for control. While immunosuppressants are inculcated to achieve control and lower the steroid dependence in T2LR, the prospect of managing a severe T2LR in conjunction with COVID-19 with the concern of worsening COVID-19 with the long term immunosuppression, as well as T2LR with the concomitant infection has not been previously encountered. We report a case of severe T2LR on oral steroids and methotrexate, who acquired COVID-19 infection during hospital stay and had a favourable outcome despite continued use of the immunosuppressives. Further, we discuss the possible reasons for this, both in terms of the drug pharmacodynamics and the immunological profile of T2LR.