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A 10 year old male child presented with a history of fever, swollen and tender bilateral elbow and interphlangeal joints for 2 days (Figure 1a and b) and intermittent fever and joint pain for the past 2 months. General and systemic physical examination revealed pallor and cervical and epitrochlear lymphadenopathy, mild hepatosplenomegaly and diffuse erythema over his face (Figure 1b). The relevent laboratory findings were Hb8mg%, TLC-15,000/mm, TPC-3·6 lacs/mm, ESR-50mm in the 1 hour, positive C-reactive protein and IgM Rheumatoid factor, normocytic normochromic anemia without any atypical cells, normal chest X-ray and negative MP-QBC. On the basis of fever, joint swelling and laboratory markers the patient was provisionally diagnosed with mild grade systemic onset juvenile idiopathic arthritis (SOJIA) and was started with naproxen. Subsequently, a few sterile bullous lesions appeared over his bilateral elbow joints and forearms (Figure 1a and b). Dermatological examination of the patient revealed a few nodules near the elbow joint and sensory loss over his bilateral hand without any hypopigmented patch. The sister of the patient had multiple hypopigmented

Bullous Erythema Nodosum Leprosum masquerading as systemic onset juvenile idiopathic arthritis: A case report