Erythema nodosum leprosum on glans penis: unusual manifestation of common disease

Background
Erythema nodosum leprosum (ENL) classically presents as tender evanescent skin nodules involving extremities, trunk, and face but may appear at any site. Mucosal involvement in ENL is uncommon, and its occurrence over glans is extremely rare.
Method
We describe two interesting cases of ENL involving the glans penis and prepuce with different presentations.
Result
The first case had lepromatous leprosy with ENL with involvement of the glans penis in the form of a painful ulcer with necrotic slough. The second case had borderline lepromatous leprosy with ENL with involvement of glans in the form of a single painful nodule. Histopathology showed features of ENL, and Ziehl-Neelsen staining showed numerous acid fast bacilli.
Conclusion
We should be aware of genital involvement of ENL, which is a rare presentation and needs to be differentiated from other conditions requiring a different management approach.