We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Necrotic Erythema Nodosum Leprosum as the First Manifestation of Borderline Lepromatous Leprosy

Athanasia Tourlaki, MD; Angelo V. Marzano, MD; Raffaele Gianotti, MD; Paolo Fiallo, MD; Enrico Nunzi, MD; Elvio Alessi, MD
Arch Dermatol. 2008;144(6):818-820. doi:10.1001/archderm.144.6.818.
Text Size: A A A
Published online


Erythema nodosum leprosum (ENL) is an immune complex–mediated reaction that may complicate the course of multibacillary leprosy. It generally occurs during antimycobacterial treatment and presents with multiple erythematous tender nodules, which add to preexisting leprosy lesions.1

Meyerson  MS Erythema nodosum leprosum. Int J Dermatol 1996;35 (6) 389- 392
PubMed Link to Article[[XSLOpenURL/10.1111/ijd.1996.35.issue-6]]
Rea  THLevan  NE Erythema nodosum leprosum in a general hospital. Arch Dermatol 1975;111 (12) 1575- 1580
PubMed Link to Article[[XSLOpenURL/10.1001/archderm.1975.01630240031005]]
Wong  WS Leprosy presenting as nodular vasculitis. Br J Rheumatol 1987;26 (5) 398
PubMed Link to Article[[XSLOpenURL/10.1093/rheumatology/26.5.398]]
Ramesh  VSaxena  UMukherjee  AMisra  RS Multiple ulcers in an elderly man: necrotizing erythema nodosum leprosum (ENL) (necrotizing ENL). Arch Dermatol 1992;128 (12) 1643- 1646
PubMed Link to Article[[XSLOpenURL/10.1001/archderm.1992.04530010081013]]
Verma  KKPandhi  RK Necrotic erythema nodosum leprosum: a presenting manifestation of lepromatous leprosy. Int J Lepr Other Mycobact Dis 1993;61 (2) 293- 294
Nishioka  SAGoulart  IMBurgarelli  MKFerreira  MSNunes-Araújo  FR Necrotizing erythema nodosum leprosum triggered by cotrimoxazole? Int J Lepr Other Mycobact Dis 1994;62 (2) 296- 297
Anshu [sic]Gangane  NVagha  SSamal  N Cytodiagnosis of erythema nodosum leprosum: a case report. Acta Cytol 2002;46 (2) 386- 387
PubMed Link to Article[[XSLOpenURL/10.1159/000326738]]
Pandhi  DMehta  SAgrawal  SSingal  A Erythema nodosum leprosum necroticans in a child: an unusual manifestation. Int J Lepr Other Mycobact Dis 2005;73 (2) 122- 126
Chauhan  SD'Cruz  SMohan  HSingh  RRam  JSachdev  A Type II lepra reaction: an unusual presentation. Dermatol Online J 2006;12 (1) 18
Andreoli  ABrett  SJDraper  PPayne  SNRook  GA Changes in circulating antibody levels to the major phenolic glycolipid during erythema nodosum leprosum in leprosy patients. Int J Lepr Other Mycobact Dis 1985;53 (2) 211- 217
Symmers  WS Sudden appearance of a lepromatous eruption during prolonged administration of stilbestrol: a case of unsuspected leprosy. Int J Lepr 1951;19 (1) 37- 43
Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.

Necrotic erythema nodosum leprosum. A, Erythematous nodules on the dorsal surface of the hand; B, targetoid skin lesions with red borders and central vesicobullae together with atrophic scars over the lower extremity; and C, ulcerative lesions covered by necrotic eschars and surrounded by an erythematous-violaceous flare.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Borderline lepromatous leprosy. A, Lamination of the perineurium with an “onionskin” appearance (hematoxylin-eosin, original magnification ×200); inset, Fite-Faraco stain shows numerous acid-fast bacilli in a skin biopsy specimen (original magnification ×400). B, Granuloma containing numerous neutrophils and foamy macrophages consistent with erythema nodosum leprosum (hematoxylin-eosin, original magnification ×400).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles