Resistance as a cause for chronic steroid dependent ENL - a novel paradigm with potential implications in management

Summary The management of Erythema Nodosum Leprosum (ENL) reactions is a challenge as the condition is chronic and recurrent, and requires treatment for a prolonged duration. The exact cause for ENL has not been ascribed, though high bacillary or antigen load perpetuates the immunological reaction. In this article, we report a case of lepromatous leprosy (LL) who presented with recurrent ENL reaction recalcitrant to therapy. Work-up showed rifampicin resistance as a potential cause for the repeated reactions and the patient responded dramatically to an alternative anti-leprosy regimen