Aberrant presentations of erythema nodosum leprosum

Erythema nodosum leprosum (ENL) typically manifests as tender, coppery nodules accompanied by systemic symptoms and visceral involvement. However, rare morphological variants, such as erythema nodosum necroticans, EMF-like ENL, Sweet Syndrome-like ENL, the Lucio phenomenon, and vesiculobullous have also been documented. This study aims to outline the aberrant presentations of ENL and correlating it with possible triggers like COVID infection. Records of Erythema nodosum leprosum patients for the period of 3 years were collected and patients with aberrant presentations were analysed retrospectively in terms of age, sex, onset of ENL episode, number of ENL episodes, spectrum of leprosy, morphology of lesions,systemic complications, bacteriological index, COVID status and treatment given. Nineteen patients were included in the study. ENL necroticans is the commonest presentation followed by ecthyma like ENL and sweet syndrome like ENL. Almost all patients 14/19(73%) has given the history of COVID infection prior to the onset of ENL and has underwent treatment. The mean ENLIST score of COVID infected individuals was 8 compared to mean ENLIST Score of covid non infected individuals which was 5. Aberrant presentations of ENL can frequently be misdiagnosed, especially in patients without a prior diagnosis of leprosy. Thus, it is crucial to maintain a strong suspicion in these cases to avoid delays in diagnosis and the resulting complications.