Leprosy lepromatous with type 2 (ENL) reaction

    This 26-year old male presented with recurrent erythematous, papulo-nodular lesions associated with fever and chills. The lesions appeared in crops. He also had joint pain and swelling. Patient complained of  nausea and vomiting along with this episode. Patient gave history of asymptomatic hypopigmented patches all over body about one year back for which no treatment was sought. He denied any family history of similar lesions.

    On examination generalized erythematous papular and nodular lesions over the trunk and extremities as well as coppery colored atrophic macular lesions on these sites were seen.

    Face, neck and genital area were spared. Ichthyosis over extremities was observed with prominence over the legs. No conjunctival congestion but slight thickening and tenderness of all the peripheral nerves. Glove and stocking anesthesia was present.

    No trophic ulcers or deformities. Swelling and tenderness of all the joints were also noted. He was pale and febrile.

    Complete blood count revealed leukocytosis & slight  neutrophilia. ESR was high. Anti cardiolipin IgG and anti cardiolipin IgG were positive.