A case of borderline leprosy is presented which first became clinically manifest, when the patient was in the United States, after an apparent and unusually long incubation period of 18 years. It was not until several weeks after the patient's admission that a skin biopsy established the correct diagnosis, and this stresses the importance of such a procedure. As exemplified by our case, erythema nodosum leprosum (ENL) can occur in borderline leprosy as well as in lepromatous leprosy. The development of reactional phases does not always necessitate a reduction or stoppage of sulfone therapy, since many other factors may be responsible for their production. An unusual discovery was the demonstration of hepatic lepromas, and in one the etiologic agent was identified. The coexistence of asthma increased the difficulty of corticosteroid withdrawal.
KWITTKEN J, PECK SM. Borderline LeprosyCase Report of a Patient With Erythema Nodosum and Hepatic Lepromas. Arch Dermatol. 1967;95(1):50-56. doi:10.1001/archderm.1967.01600310056012