{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T04:04:04Z","timestamp":1780113844045,"version":"3.54.0"},"reference-count":11,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background: Leprosy, caused by Mycobacterium leprae, presents on a spectrum ranging from tuberculoid to lepromatous disease. Borderline lepromatous leprosy represents an unstable immunological state that predisposes patients to immune-mediated reactions, including erythema nodosum leprosum (ENL), a severe inflammatory complication. Case Presentation: We report a case of a 62-year-old female with borderline lepromatous leprosy who presented with recurrent facial cellulitis and later developed disseminated ENL. She was initially diagnosed following a series of facial infections and confirmatory skin biopsy. Months later, she developed systemic inflammatory lesions consistent with ENL, requiring hospitalization. She was treated with high-dose corticosteroids for ENL and methotrexate to treat type 1 reaction and continued multidrug therapy (MDT) with minocycline, rifampin, and clarithromycin for leprosy, which led to significant clinical improvement. Conclusion: This case highlights the diagnostic challenges of leprosy in the United States and the importance of recognizing ENL as a severe immunologic complication requiring prompt intervention. A multidisciplinary approach is essential for optimal patient outcomes.<\/jats:p>","DOI":"10.3390\/idr17040083","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T14:22:36Z","timestamp":1752243756000},"page":"83","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Erythema Nodosum Leprosum in a Patient with Borderline Lepromatous Leprosy: A Case Report"],"prefix":"10.3390","volume":"17","author":[{"given":"Guido","family":"Chiriboga","sequence":"first","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianyu","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9754-4149","authenticated-orcid":false,"given":"Eric","family":"Zuberi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5308-1575","authenticated-orcid":false,"given":"Harry Ross","family":"Powers","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6964-5956","authenticated-orcid":false,"given":"Libardo","family":"Rueda Prada","sequence":"additional","affiliation":[{"name":"Department of Hospital Internal Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mi, Z., Liu, H., and Zhang, F. (2020). Advances in the Immunology and Genetics of Leprosy. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.00567"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.jaad.2014.03.034","article-title":"Recognizing and managing the immunologic reactions in leprosy","volume":"71","author":"Kamath","year":"2014","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"366","DOI":"10.47276\/lr.74.4.366","article-title":"WHO disability grading: Operational definitions","volume":"74","author":"Brandsma","year":"2003","journal-title":"Lepr. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1128\/CMR.19.2.338-381.2006","article-title":"The continuing challenges of leprosy","volume":"19","author":"Scollard","year":"2006","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ploemacher, T., Faber, W.R., Menke, H., Rutten, V., and Pieters, T. (2020). Reservoirs and transmission routes of leprosy; A systematic review. PLoS. Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008276"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.3201\/eid2908.220367","article-title":"Case Report of Leprosy in Central Florida, USA, 2022","volume":"29","author":"Bhukhan","year":"2023","journal-title":"Emerg. Infect Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.trstmh.2008.01.004","article-title":"Towards understanding the pathology of erythema nodosum leprosum","volume":"102","author":"Kahawita","year":"2008","journal-title":"Trans. R Soc. Trop. Med. Hyg."},{"key":"ref_8","first-page":"CD006949","article-title":"Interventions for erythema nodosum leprosum","volume":"2009","author":"Veen","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","unstructured":"National Hansen\u2019s Disease Program (2025, April 22). NHDP Guide to the Management of Hansen\u2019s Disease. National Hansen\u2019s Disease Program: Guide to the Management of Hansen\u2019s Disease, Available online: https:\/\/www.hrsa.gov\/sites\/default\/files\/hrsa\/hansens-disease\/hansens-disease-guide-management.pdf."},{"key":"ref_10","unstructured":"World Health Organization (2025, April 21). Guidelines for the Diagnosis, Treatment and Prevention of Leprosy. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789290226383."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1128\/CMR.00079-13","article-title":"Leprosy in the 21st century","volume":"28","author":"White","year":"2015","journal-title":"Clin. Microbiol. Rev."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/4\/83\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:08:21Z","timestamp":1760033301000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/4\/83"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,11]]},"references-count":11,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["idr17040083"],"URL":"https:\/\/doi.org\/10.3390\/idr17040083","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,11]]}}}