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Introduction
Type 2 lepra reaction, otherwise termed erythema nodosum leprosum, is an acute inflammatory reaction seen in patients with lepromatous leprosy or occasionally in borderline lepromatous leprosy. Though it is usually seen during the course of treatment it may occur in previously untreated patients as well. The lesions described in type 2 reactions are erythematous painful tender papules and nodules. In mild reaction nodules are small in number and spontaneously resolve leaving behind hyperpigmented macules. In severe reactions, nodules tend to increase in size and ulcerate. Ulcerations heal with scarring. Sometimes erythema nodosum leprosum may be the presenting manifestation of leprosy [1]. Vesiculobullous, pustular, ulcerated, and hemorrhagic and erythema multiforme-like lesions have been reported in ENL (erythema nodosum leprosum) [2]. In this article, we have discussed a case which presented to us with severe skin ulcerations. The case was admitted in our hospital, MVJ medical college and research hospital, situated in the outskirts of Bangalore, where she was investigated and diagnosed and started on treatment. ;
Case Report
A 45 year old lady was brought to our OPD with multiple painful ulcerated skin lesions over the trunk, arms, thighs and gluteal area of 2 months duration. She also had multiple reddish eruptions and pustules over the face since 1 week; she gives history of recurrent attacks of papulo-pustular lesions, and ulceration since three years. Patient says that she was taking treatment from a doctor with partial subsidence of ulcers. It is possible that patient must have been put on steroid injections as history suggests. Six months ago she was diagnosed to have diabetes mellitus and she has been on irregular treatment for the same. In the present episode ulceration first started over the gluteal region and slowly developed over the other sites. According to the patient the present episode was the most severe one. Current episode is associated with history of fever since 1week – high grade and intermittent. No history of joint pains or abdominal symptoms suggestive of inflammatory bowel disease. On general physical examination, the patient was afebrile, vitals were stable,pallor was present and there were enlarged tender lymph nodes in the cervial, axillary...