02906nas a2200253   4500000000100000008004100001260003000042653002700072653003000099653002100129653002200150653001200172100002400184700001800208700001700226700001700243700002000260245012400280856006100404300001400465490000600479520215300485022001402638       2025                            d  bHanif Medisiana Publisher10aBorderline lepromatous10aErythema Nodosum Leprosum10aHansen's disease10aTreatment default10aLeprosy1 aRendra Darmasatria 1 aTutty Ariani 1 aYosse Rizal 1 aRina Gustia 1 aIrdawaty Izrul 00aThe 15-Year Shadow: Borderline Lepromatous Leprosy with Erythema Nodosum Leprosum Following Prolonged Treatment Default  uhttps://www.bioscmed.com/index.php/bsm/article/view/1405  a9048-90630 v93 a<p><strong>Background:</strong> Leprosy, caused by Mycobacterium leprae, persists as a global health issue where the primary challenges are not merely microbial but are deeply rooted in delayed diagnosis and poor treatment adherence. These delays, often driven by profound social stigma, lead to progressive, irreversible disability and sustain community transmission. Erythema Nodosum Leprosum (ENL), an acute immunological complication, further devastates patients' quality of life and complicates management.</p>

<p><strong>Case presentation:</strong> A 53-year-old Indonesian farmer presented with a 15-year history of untreated leprosy, a journey of neglect initiated by fear of treatment side effects and community ostracism. Clinical examination revealed advanced borderline lepromatous (BL) leprosy with diffuse skin infiltration, multiple anesthetic plaques, and thickened, tender peripheral nerves. He had established WHO Grade 1 disability, characterized by significant sensory loss in his hands and feet and early intrinsic muscle atrophy. A slit-skin smear confirmed a bacteriological index of +3 with a morphological index of 5%, indicating a high load of viable bacilli. Histopathology confirmed BL leprosy with a concurrent mild ENL reaction. A comprehensive, patient-centered management plan was initiated, including a 12-month course of multidrug therapy (MDT-MB), adjunctive care, and intensive counseling.</p>

<p><strong>Conclusion:</strong> This case powerfully illustrates the "shadow effect" of leprosy—how years of untreated disease, fueled by psychosocial barriers, culminate in a complex nexus of advanced infection, immunological reaction, and permanent neurological impairment. The patient's successful re-engagement with the health system underscores that eradicating the burden of leprosy requires a paradigm shift from a purely pharmacological approach to a deeply humanistic one. Effective control hinges on building compassionate health systems that actively dismantle stigma, empower patients with knowledge, and deliver holistic, multidisciplinary care to prevent the profound human cost of neglect.</p>
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