Bullous erythema nodosum leprosum: a rare case series

Bullous erythema nodosum leprosum (Bullous ENL) is the severe form of Type 2 lepra reaction. There are only a handful of reports of bullous ENL cases in English literature. We hereby report five cases of lepromatous leprosy with bullous erythema nodosum leprosum, of whom cases 1, 3, 4 and 5 had bullous ENL at initial presentation, while case 2 developed bullous lesions during the fourth episode of ENL. The diagnosis was based on clinical features and histopathology. All cases had a bacillary index more than 4+. None of the patients had a history of previous antileprosy treatment. A history of contact with another person with leprosy was present in two cases. All five cases were successfully treated with multidrug therapy, oral steroids and thalidomide. This case series on bullous ENL emphasises that a high bacillary index and delay in diagnosis and treatment can lead to the more severe form of bullous Type 2 lepra reaction.