01546nas a2200145   4500000000100000008004100001100001600042700001200058700001700070245008600087856008000173300001200253490000700265520112800272       2020                            d1 aGulanikar A1 aAbrol A1 aTariq Iqba M00aA Rare Case of Erythema Nodosum Leprosum Presenting Clinically as Type 1 Reaction  uhttp://www.ijl.org.in/2020/08%20Gulanikar%20et%20al%20(119-124)%20final.pdf  a119-1240 v923 aLeprosy reactions represent acute immunologically mediated inflammatory episodes, which may interrupt the otherwise chronic course of Leprosy. They are of two major types - Type 1 Lepra reaction, or Reversal reaction, and Type 2 Lepra reaction or ENL. Reactional states in leprosy are the most common cause of permanent nerve damage, deformity, and disability. However, atypical presentations of reactions may pose a diagnostic challenge for the treating dermatologist. Here we report an unusual case of Lepra reaction clinically presenting as Type 1 reaction, and having histological features of ENL. The patient presented with erythematous, edematous and infiltrated plaques as the predominant lesions, with a history of recurrent episodes of such lesions, associated with constitutional symptoms. The clinical picture was in favor of BT downgrading to BL leprosy in Type 1 reaction. On the basis of the histopathological findings, a diagnosis of ENL was suggested. However, absence of typical ENL lesions, and clinical resemblance of the lesions to Type 1 reaction makes this case unusual and hence it is being reported.