Coexistence of Scrofuloderma and Lepromatous Leprosy in Reaction: A Case Report

Leprosy and tuberculosis (TB) are both chronic granulomatous infections caused by bacilli of the genus <i>Mycobacterium</i>. The simultaneous occurrence of cutaneous tuberculosis and leprosy is rare. We report a 56-year-old male presenting with painful erythematous nodules and plaques over the face and extremities for 1 week, along with asymptomatic right axillary lesions for 1 year. Examination revealed tender nodules and plaques with ulceration on the face and extremities, and firm, matted subcutaneous nodules with sinus tracts in the axilla. Sensory loss in a glove-and-stocking distribution and peripheral nerve enlargement were also noted. Slit-skin smear demonstrated a Bacteriological Index of 6+, while histopathology of the axillary lesion showed caseous necrosis with epithelioid granulomas. The patient was diagnosed with lepromatous leprosy in type 2 lepra reaction with scrofuloderma and treated with modified multibacillary multidrug therapy, anti-tubercular therapy, and corticosteroids, achieving a favorable clinical response. This case report aims to describe a rare co-occurrence of leprosy and tuberculosis, highlighting the immunological interplay between the two conditions and the importance of comprehensive diagnostic evaluation and individualized management in endemic settings.