Type II Reaction Erythema Nodosum Leprosum: A Case Report

Abstract

Leprosy, or Hansen's disease, is a chronic granulomatous infectious disease caused by Mycobacterium leprae. This is a case of a 25-year-old male from Micronesia who presented to a hospital in the Midwest with a two-week history of a widespread, nodular, erythematous, painful rash most severe on his lower extremities and sparing only his hands and feet. In addition to the cutaneous manifestations, the patient met the criteria for Systemic Inflammatory Response Syndrome (SIRS) due to his presentation of tachycardia, tachypnea, leukocytosis, and elevated inflammatory markers. A short course of antibiotics, including Piperacillin-Tazobactam and Vancomycin, and IV steroids were started on admission. A skin biopsy taken from the center and edge of a lesion on the patient’s right arm demonstrated acute and chronic granulomatous superficial and deep inflammation with abundant acid-fast bacilli consistent with lepromatous leprosy from a Mycobacterium leprae infection. Once the National Hansen's Disease Center was contacted previous therapies were stopped and a multidrug therapy, consisting of Rifampin, Moxifloxacin, Minocycline, Methotrexate, and Prednisone was started. The multidrug therapy promptly resulting in substantial clinical improvement over the subsequent months. This case emphasizes the significance of early recognition, accurate diagnosis, and timely initiation of appropriate treatment in leprosy management, even in unlikely regions such as the Midwestern United States.