Vasculonecrotic Erythema Nodosum Leprosum in a Case of Lepromatous Leprosy: A Rare and Severe Presentation

Abstract

Lepromatous leprosy, caused by Mycobacterium leprae or Mycobacterium lepromatosis, is a progressive, multi-systemic infection affecting the skin and peripheral nerves. Erythema nodosum leprosum (ENL) is a severe immunological complication in lepromatous and borderline leprosy, presenting with inflamed skin nodules. Vasculonecrotic ENL, a rare form, involves deep ulcerations, necrosis, and systemic effects. We report a 40-year-old Myanmarese male with multibacillary leprosy presenting with erythematous patches, nodules, and vesiculopustular bullous eruptions on the trunk and extremities, with bilateral median nerve enlargement and sensory loss. Histopathology confirmed lepromatous leprosy with necrotizing vasculitis and neutrophil infiltration, leading to a diagnosis of vasculonecrotic ENL. Despite initial improvement with multidrug therapy and oral corticosteroids, the patient experienced a relapse of bullous lesions and neuritis following prednisolone tapering. Treatment was intensified with high-dose corticosteroids, leading to the resolution of his bullous lesions.