Nodular and abscessed pinna in lepromatous leprosy with Type 2 lepra reaction

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae , with a predilection for cooler areas of the body such as the external ear. We report a man in his late thirties with lepromatous leprosy, presenting with an eight-month history of facial and auricular nodules that progressed to erythema, ulceration, and sensory impairment. The clinical examination revealed infiltrated, nodular pinnae, a cheek ulcer, and bilateral ulnar neuritis. Slit-skin smear revealed abundant acid-fast bacilli (BI 6 +), and histopathology confirmed the multibacillary spectrum. The acute erythema, painful tender nodules, and neuritis were consistent with a Type 2 lepra reaction (erythema nodosum leprosum, ENL). The patient was treated with the WHO-recommended multidrug therapy for multibacillary leprosy (MB-MDT) and oral corticosteroids, showing progressive clinical improvement. This case underscores that external ear involvement, though a recognized feature of multibacillary leprosy, may be easily overlooked, particularly when complicated by lepra reactions. Timely recognition and prompt management of lepra reactions are essential to prevent irreversible neuropathy and disfigurement. • Rare case of lepromatous leprosy presenting with nodular and abscessed pinnae. • Exceptionally high bacillary (BI 6 +) and morphological index (MI 90 %) observed on slit-skin smear. • Type 2 lepra reaction (ENL) superimposed on active lepromatous disease with neuritis. • Early recognition and corticosteroid therapy prevented irreversible nerve damage. • Underscores diagnostic value of auricular involvement and ongoing rural transmission risk.