History:

 A 45-year-old male patient , presented with multiple papulonodular erythematous tender nodules on the face and extremities. The patient has just started MDT for LL two months ago. Examination; multiple erythematous tender nodules , 2-4 cm in diameter on the face, and extensors of extremities. Lesions were associated with fever and arthritis. Based on the history , clinical examination, laboratory investigations (Increased ESR, CRP, Leukocytosis), a diagnosis of ENL was settled.The patient continued the MDT, start on prednisolone 40 mg/day with gradual withdrawal over 6 months with indomethacine 150 mg/day & pentoxifylline 400 mg thrice/day..Unfortunately, thalidomide is not available in Egypt, a drug to which ENL shows dramatic improvement.

This case is submitted by Dr. Ayman Abdelmaksoud, MD, Egypt.