Familial clustering of severe atypical variants of erythema nodosum leprosum in immunocompetent siblings

Erythema nodosum leprosum is characterised by brightly erythematous tender nodules or plaques usually in bilateral symmetrical distribution. ENL can also present in several atypical presentations like pustular, erythema multiform like, ulcerative, necrotic, panniculitic and bullous forms. Various precipitating factors for ENL include stress, pregnancy, surgery, lactation, menstruation, infections and sometimes therapy. We report two rare varities of ENL pustular ENL and bullous variant manifesting simultaneously in 2 siblings of a family.