A Case of Lepromatous Leprosy with Type 2 Lepra Reaction and Multidrug-Resistant Tuberculosis: Diagnostic and Therapeutic Challenges

Background: Leprosy, caused by Mycobacterium leprae, is a chronic infectious disease often complicated by immune-mediated reactions. Type 2 lepra reaction, or erythema nodosum leprosum (ENL), is characterized by systemic inflammatory symptoms requiring immunosuppressive therapy. Co-infection with multidrug-resistant tuberculosis (MDR-TB) further complicates management and prognosis. Case Presentation: A 35-year-old male presented with abdominal pain, loose stools, vomiting, and dusky erythematous skin lesions. He was diagnosed with lepromatous leprosy and initiated on multidrug therapy. Subsequently, he developed ENL manifesting as flared-up lesions, facial puffiness, and small joint pain, necessitating corticosteroid treatment. Two months later, he was diagnosed with MDR-TB with right-sided pleural effusion and lung collapse, which was successfully managed with a Bedaquiline-based regimen. Conclusion: This case highlights the diagnostic and therapeutic challenges posed by the coexistence of leprosy, ENL, and MDR-TB. Early recognition, multidisciplinary care, and integrated management strategies are essential for achieving favourable outcomes in such complex presentations.