Erythema nodosum leprosum (ENL) mimicking Pityriasis lichenoides et varioliform acuta (PLEVA): An atypical presentation

Erythema Nodosum Leprosum (ENL) or Type 2 lepra reaction is found in the lepromatous pole of leprosy.1 It usually presents as tender, erythematous, evanescent nodules associated with systemic features. Besides nodular lesions, various reported atypical presentations of ENL include pustular, bullous, ulcerated and erythema multiforme-like lesions. Atypical presentations often lead to delay in diagnosis and treatment which may lead to severe systemic complications in ENL. We are reporting a 50 year old male who presented with recurrent papular and pustular crusted skin lesions associated with mild fever and was misdiagnosed as PLEVA initially, but later on was proved to have lepromatous leprosy with erythema nodosum leprosum on histopathology.