# Revealing Erythema Nodosum Leprosum in a Leprosy Patient: A Case of Treatment Noncompliance

## TL;DR

A leprosy patient developed severe inflammation after stopping treatment, highlighting the importance of following medical advice to avoid complications.

## Contribution

This case highlights the clinical consequences of treatment noncompliance in leprosy patients, emphasizing the risk of Type-2 lepra reactions.

## Key findings

- Noncompliance with MDT can trigger severe systemic inflammation resembling sepsis.
- Early recognition and management of ENL are crucial to prevent complications.
- Type-2 LR occurs predominantly in lepromatous leprosy patients during or after treatment.

## Abstract

Lepra reactions (LR) are acute inflammatory conditions with immune mediators that are highly morbid. Patients with the lepromatous end of the leprosy spectrum (BL-LL) are the only ones who develop Type-2 LR. 90% of the time, it happens during or right after treatment, usually within 2 years. The emergence of Erythema Nodosum Leprosum (ENL) suggests a paradoxical immune reaction and hypersensitivity to leprosy bacteria that results in painful erythematous nodules and systemic symptoms. Here, we present a case of Type 2 LR in a 41-year-old Indian man diagnosed with lepromatous leprosy 2 years ago. He was treated with MDT regime for 12 months and was compliant with treatment till 1 month before presenting with fever, cough, red eyes, and painful erythematous nodules involving his trunk and extremities. This case underscores the severe systemic inflammatory response that can be triggered by noncompliance with MDT, mimicking sepsis and requiring prompt recognition and management. Early recognition of ENL and appropriate management are essential to alleviate symptoms and prevent serious complications that may result from this serious condition.