01601nas a2200169   4500000000100000008004100001653001600042653002100058653002700079653002600106100001500132700001300147245011600160856008100276300000800357520106600365       2025                            d10aClofazimine10aErythema Nodosum10aMultibacillary leprosy10aMycobacterium leprae 1 aSamsudin S1 aHamzah F00aErythema   Nodosum   Leprosum   in   a   Treatment-Naïve   Patient: Clinical Clues Not to Miss in Primary Care  uhttps://ejournal.unikl.edu.my/index.php/ajmhs/article/download/1021/887/2771  a1-73 a<p>Leprosy is known as a “great mimicker” due to its broad spectrum of clinical presentations. Erythema nodosum leprosum (ENL), a Type 2 lepra reaction, typically manifests as acute, painful erythematous nodules during or after initiation of multidrug therapy(MDT) in multibacillary patients. We report a case of a 66-year-old treatment-naïve man who presented to primary care with chronic and painless nodules in the absence of classical lepromatous features or prior therapy. Slit-skin smear (SSS) confirmed multibacillary leprosy with a moderate bacterial index (BI) and an inactive morphological index (MI), supporting the diagnosis of chronic ENL. The patient responded well to a second-line MDT regimen and corticosteroids. This case highlights an unusual presentation of ENL preceding treatment and underscores the diagnostic challenges faced in primary care, particularly when classical signs of leprosy are absent. We discuss key differential diagnoses and the importance of early recognition to avoid misdiagnosis and prevent complications.</p>