Case Vignette

A 43-year-old male, farmer with no known comorbidities, presented with history of recurrent fever for one year and painful nodular skin lesions over bilateral upper limb and trunk for 2.5 years, progressively increasing in number. Examination revealed tender erythematous nodules and thickened peripheral nerves, including bilateral ulnar and greater auricular nerves. Laboratory evaluation showed markedly elevated ESR, while blood culture and other microbiological work-up returned negative. Slit-skin smear demonstrated acid-fast bacilli (5+), and skin biopsy done was consistent with erythema nodosum leprosum (ENL). Empirical antibiotics which were started were stopped. Diagnosis of lepromatous leprosy with type 2 lepra reaction was considered, and the patient improved with systemic corticosteroids and multidrug therapy (MDT). 

ANSWER: The answer will be released in the upcoming September 2026 issue.