Type 2 Lepra Reaction Presenting as Pyrexia of Unknown Origin: A Case Report

Background: Type 2 lepra reaction, also known as erythema nodosum leprosum (ENL), is an immune complex–mediated complication of multi bacillary leprosy [1]. Rarely, it may present predominantly with prolonged fever, leading to diagnostic delay and presentation as pyrexia of unknown origin (PUO) [5].

Case Presentation: A 37-year-old male presented with intermittent high-grade fever and recurrent painful subcutaneous nodules for eight months. Clinical examination revealed multiple tender nodules, peripheral nerve thickening, and cervical lymphadenopathy. Laboratory evaluation showed leucocytosis and elevated erythrocyte sedimentation rate. Split-skin smear from multiple sites demonstrated abundant acid-fast bacilli with a high bacillary load and a morphological index of 40%. A diagnosis of lepromatous leprosy with Type 2 lepra reaction was made. The patient showed significant improvement following WHO-recommended multidrug therapy and systemic corticosteroids [3,9].

Conclusion: Type 2 lepra reaction should be considered in the differential diagnosis of PUO, particularly in leprosy-endemic regions [5,7].