ENL Necroticans at a Tertiary Care Centre – A Case Series

Lepra reactions particularly the severe forms constitute a great concern of mortality and morbidity, and the severe forms like ENL necroticans is underestimated. We hereby report four cases of ENL necroticans. The first case was a 45-year-old male patient presented with multiple erythematous nodules on the trunk and extremities along with ulceration of nodules for 15 days. He had a history of ENL without ulceration 5 year back. Our second case was a 40-year-old male presented with a 15 days history of multiple ulceration along with nodular lesion over extremities. He also has a history of ENL on and off since the last 1 year. Third case was st a forty-year male on MB-MDT 1 pack presented with ulceration with ENL lesions for 1 month; he had a history of on and off ENL without ulceration since the last 6 months; and fourth one was a 35-year-old male presented th with similar nodular and ulcerated lesions since 4 days, and he was on the 12 pack of MB MDT. Fever was present in all the patients. Turbid bullae/pustules were noted in three patients. Neuritis was present in one, and Grade 2 disability was seen in three patients. All the cases were treated with systemic corticosteroid, thalidomide and clofazimine, and they responded well to therapy. Necrotic ENL cases are reporting to hospitals more frequently than reported earlier; some of them had an uncommon presentation.