Managing a Case of Steroid Dependant Erythema Necroticans in a Severely Immune-compromised Patient: Case report

Erythema necroticans is a severe manifestations of type 2 lepra reaction manifested as painful, ulcerated nodules distributed over limbs & trunk, associated with systemic symptoms. Oral glucocorticoids are used as first line therapy to arrest the progression. However, due to relapsing & remitting course of disease, chronic steroid use land up into many dreadful complications. Here we are reporting a case having chronic steroid dependent erythema necroticans with tuberculosis which can be a therapeutic challenge in the field of dermatology. History revealed that the patient had self-administered steroids and thalidomide for one and half year which was earlier prescribed for an episode of severe ENL and tapered off. During the course of disease, she developed tubercular arteritis leading to stroke which proved fatal. There is immense need for adequate and appropriate counselling of such patients suffering from recurrent episodes of lepra reactions.