02293nas a2200289   4500000000100000008004100001260001200042653002500054653002700079653004500106653002600151653002600177653002100203100001400224700001100238700001600249700001200265700001400277700001300291700001800304700001300322245015500335856015300490300001100643520133500654022001401989       2026                            d  c06/202610aDiagnostic challenge10aMultibacillary leprosy10aNecrotic erythema nodosum leprosum (ENL)10aNegative bacilloscopy10aSteroid-dependent ENL10aVasculitis mimic1 aSaputra A1 aAmin S1 aZainuddin A1 aKadir D1 aAdriani A1 aRahmah S1 aDjamaluddin W1 aMuhlis M00aNecrotic Steroid-Dependent Erythema Nodosum Leprosum Mimicking Vasculitis in Multibacillary Leprosy with Negative Bacilloscopy: A Diagnostic Challenge  uhttps://www.sciencedirect.com/science/article/pii/S1201971226005096/pdfft?md5=8499d1e841f4e20a8985009c9f86452e&pid=1-s2.0-S1201971226005096-main.pdf  a1 - 143 a<p>Necrotic erythema nodosum leprosum (ENL) is a rare, severe and atypical variant of type 2 reaction characterized skin lesions mimicking vasculitis. Bacilloscopy and histopathological features may not be suggestive, in patients with repeated cycles of multidrug therapy (MDT) and concomitant use of corticosteroids. A 20-year-old man previously diagnosed with multibacillary leprosy received repeated cycles of MDT, at which time he developed recurrent painful nodules that worsened to widespread necrotic ulcers. Although previous bacilloscopy was positive, repeated test during severe ulcerative presentation was negative. Skin biopsy showed extensive ulceration, lobular panniculitis, and medium-vessel vasculitis without granuloma formation. Acid-fast bacilli were not detected on Ziehl-Neelsen staining. Recurrent episodes of flaring were experienced every time the corticosteroid dose was tapered. Necrotic steroid-dependent ENL was diagnosed based on clinicopathological correlation. High-dose corticosteroid therapy was then given, which resulted in complete remission and hypertrophic scarring. No recurrence was experienced during follow-up. Negative bacilloscopy and uncharacteristic histological findings do not exclude necrotic ENL as a differential diagnosis in patients with vasculitic ulceronecrotic lesions.</p>  a1878-3511