Pathogenesis of bullous erythema nodosum leprosum: a case report

A 54 years old male, presented with acute onset of fever, malaise and body ache and multiple painful reddish swellings and fluid filled lesions in different parts of body. He gave history suggestive of several earlier episodes of type 2 lepra reactions with erythema nodosum leprosum lesions which were managed with corticosteroids. Dermatological examination revealed multiple erythematous tender nodules and plaques on face, extremities and trunk. He also had multiple bullous lesions on trunk. Investigations revealed polymorphonuclear leukocytosis and raised ESR. Biochemical investigations were normal. Slit skin smear examination showed fragmented acid fast bacilli with bacteriological index of 5+