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

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