Recurrent erythema nodosum leprosum in a multibacillary leprosy patient post-multi drug therapy: a case report

Erythema Nodosum Leprosum (ENL) is a serious immunological consequence that primarily affects patients with the lepromatous and borderline lepromatous types of the disease. The reaction involves immune complex deposition, complement activation, and increased proinflammatory cytokines, including TNF-α, IL-6, IL-8, and IL-10. A 41-year-old male patient with a previous diagnosis of multibacillary leprosy appeared with severe erythematous nodules and new hypopigmented patches on his extremities. He had already finished 11 cycles of MBMDT. Numerous erythematous, skin-coloured plaques and nodules were found during the clinical examination. His systemic assessment and slit-skin smear supported the diagnosis of Erythema Nodosum Leprosum (ENL), a type 2 lepra response. The patient demonstrated resistance to continued MDT, which was successfully controlled with intravenous dexamethasone and supportive care. This example emphasizes the necessity of early detection and careful management of lepra responses in order to avoid long-term consequences