Leprosy is multi-organ infectious disease affecting mainly the skin and nerves. Since the symptoms and physical findings depend on the stage of the disease and level of infection, case diagnosis and detection are not always clear or consistent. In certain individuals, leprosy may present acutely, and this is called a lepra reaction. Lepra reactions, which occur during or before this disease, are acute episodes that are divided into type 1 and 2 lepra reactions. We report a case of borderline lepromatous leprosy with recurrent pustular skin lesions and fever. A 60-year-old female was hospitalized for fever, iridocyclitis, and a skin rash. The patient had a type 2 lepra reaction manifest with fever, neuritis, arthritis, iridocyclitis, and pustular skin lesions. Leprosy was confirmed histologically and bacteriologically from a biopsy of the skin lesions. (Korean J Med 75:S904-S908, 2008)