Necrotic steroid-dependent erythema nodosum leprosum mimicking vasculitis in multibacillary leprosy with negative bacilloscopy: a diagnostic challenge.
Anthony Wirawan Saputra, Safruddin Amin, Andi Nurhaerani Zainuddin et al.
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Case in brief
A 20-year-old man with multibacillary leprosy developed recurrent painful nodules that progressed to widespread necrotic ulcers after multiple cycles of multidrug therapy and corticosteroid use. Despite a history of positive bacilloscopy, tests during the ulcerative phase were negative. A skin biopsy revealed lobular panniculitis and medium-vessel vasculitis. The diagnosis of necrotic steroid-dependent erythema nodosum leprosum was made, and high-dose corticosteroids led to complete remission.
What made this case unusual
The case highlights necrotic erythema nodosum leprosum presenting with negative bacilloscopy and atypical histological findings, mimicking vasculitis.
Diagnostic / clinical pearl
Clinicians should consider necrotic erythema nodosum leprosum in patients with ulcerative lesions, even when bacilloscopy is negative and histology is atypical.
Why it matters
This case underscores the importance of clinicopathological correlation in diagnosing complex presentations of leprosy, particularly in steroid-dependent cases.