Authors: Irsalina Husna Azwir, Widyawati Djamaluddin, Safruddin Amin, Sri Vitayani Muchtar, Dirmawati Kadir, Anni Adriani


Introduction: Erythema nodusum leprosum (ENL) is a leprosy reaction mediated by type III hypersensitivity reaction. It is characterized by painful erythematous nodules preceded by prodromal symptoms and may occur before, during, or after treatment.

Case Report: We report a 31-year old male with generalized painful erythematous nodules and intermittent fever in the last 3 months. The patient was previously diagnosed with multibacillary (MB) leprosy and was prescribed and WHO multidrug therapy (MDT) 3 years ago. Following completion of the therapy, the lesions still frequently recurred and was treated with 20 mg/day prednisone. However, once the treatment was stopped, nodules grew back and prompted re-administration of prednisone. Histopathology examination showed epidermal atrophy, granuloma in the dermis, bacilli in the blood vessel and foamy cells. The patient was subsequently successfully treated with MDT-MB and 30 mg/day prednisone tapered down every 2 weeks.

Conclusion: This case describes a recurrent ENL reaction in a MB leprosy patient which was successfully treated with oral corticosteroid and MDT MB regimen. Proper understanding of the pathomechanism of ENL reaction is needed to administer optimal management approach.





Erythema Nodusum Leprosum (ENL), Leprosy, Multibacillary, Recurrent

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