Bullous erythema nodosum as initial manifestation of leprosy

Introduction: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae with protean manifestations, particularly prone to affect skin and peripheral nerves. The natural course of the disease may be associated with the development of type 1 or type 2 immunologic reactions. These immunologic reactions are reported to be caused by increased activity of the immune system, particularly a cell-mediated immune response against live leprosy bacillus or remnants of dead bacilli. Leprosy is one of the oldest diseases of mankind. Its clinical diagnosis can be challenging due to the varied manifestations. The first description of bullous erythema nodosum was made 1898 and since then there are few recorded reports. Case Report: Here we present a case of bullous erythema nodosum as leprosy first manifestation. A 35 year-woman presented with 1-year history of disseminated blisters on trunk, forearms and thighs, and multiple painful ulcerated nodules on her face. She reported that the lesions in her face became eroded and ulcerated spontaneously. There were no thickened nerves. Blood and Histopathological investigations were made. The treatment instituted was prednisone 1mg/kg without thalidomide. After two weeks with excellent response, specific therapy for Mycobacterium leprae was initiated by the infectious diseases assistant physician with a satisfactory response.