Resident Rounds Part III: Case Report: A Papulo-Nodular Eruption With Systemic Signs and Symptoms

April 2015 | Volume 14 | Issue 4 | Features | 422 | Copyright © April 2015

Lindsey E. Richards BS, Mary E. Horner MD, and Alan Menter MD

Department of Dermatology, Baylor University Medical Center, Dallas, TX Texas Dermatological Associates, Dallas, TX

This is a typical presentation of erythema nodosum leprosum in a patient with lepromatous leprosy who recently migrated from Micronesia. The clinical presentation, pathology findings, pathogenesis, and therapeutic options are reviewed here.


A 27-year-old male who had migrated from Micronesia 12 days previously presented with a 2-day history of rash, fever, weight loss (25 lbs), night sweats, and acute pain in his left leg that prevented ambulation. Upon examination, he was observed to have scattered discrete 5 mm to 15 mm erythematous papules and nodules on the trunk and extremities (Figure 1), skin-colored nodules on his earlobes bilaterally, and a 30 mm erythematous and tender left inguinal lymph node. He had no mucus membrane or neurologic abnormalities. Laboratory abnormalities included a leukocytosis and elevated serum lactate.