BRIEF REPORT Erythema Nodosum Leprosum: Report of Two Cases Roopak Aggarwal, M.B.B.S., M.D., 1 Oneal Gupta, M.B.B.S., D.C.P., DNB (STD.), 1 * Shaham Beg, M.B.B.S., M.D., 1 and Rajni Prasad, M.B.B.S., M.D. 2 Erythema nodosum leprosum (ENL) or type 2 lepra reaction is an inflammatory reaction, which may occur in the course of hansenia- sis, may compel the patient to seek medical attention and may result in nerve function impairment and subsequent disability. Thus, recognition and timely management of these patients is criti- cal in order to avoid permanent disability. Fine-needle aspiration cytology is simple and effective tool that aids in the correct diag- nosis and management of ENL. Herein, we present two cases of ENL, one with typical and another with atypical presentation. Diagn. Cytopathol. 2011;00:000–000. ' 2011 Wiley-Liss, Inc. Key Words: erythema nodosum leprosum; aspiration cytology Introduction Hanseniasis is a disease in which Mycobacterium leprae affects cooler parts of the body, such as skin and periph- eral nerves. 1 Nerve affliction whether clinical or micro- scopic, may occur with or without concurrent skin involvement. 2 The cornerstone of the effective manage- ment of hanseniasis remains early detection and treatment of nerve damage. 3 Skin slit smear stained for acid fast ba- cilli (AFB) have been conventionally used for the assess- ment of hanseniasis lesions but their use have been re- stricted to the evaluation of bacterial index and morpho- logical index. Reports on primary cytodiagnosis of hanseniasis lesions by fine-needle aspiration cytology from skin, nerve, and lymph nodes are very few in the literature. 4,5 The present report describes the cytomorphological diagnostic features of erythema nodosum leprosum (ENL) by fine needle aspiration cytology (FNAC). Case Reports Case 1 A 12-year-old boy presented with fever and raised nodu- lar lesions all over the body, with history of itching since 2 months and was taking dapsone therapy. On clinical examination, multiple erythematous papules and nodules were present over the forearms, elbow, neck, abdomen, and back. Few lesions show central indentation with excoriation and crusting. Routine blood examination was normal. Fine-needle aspiration cytology from forearm lesion was performed using the 22-gauge needle attached to a 10-ml syringe. Grossly the aspirate was thick, white with negligible contamination with blood. Air-dried May- Gru ¨nwald Geimsa (MGG) and alcohol fixed H&E-stained smears were cellular and showed numerous foamy macro- phages in a background of lipocytes. Many neutrophils were seen infiltrating the foamy macrophages (Fig. 1). Wade fite stain showed the cells containing numerous fragmented AFB (Fig. 2). A diagnosis of ENL was given on cytology which was confirmed subsequently by the histopathological examination of skin biopsy from the forearm swelling (Fig. 3). Case 2 A 8-year-old girl presented with fever and multiple nodu- lar eruption all over the body of abrupt onset. On clinical examination, the nodules were multiple nontender, firm to soft in consistency of size 0.5–3 cm. The patient did not have any history of antileprotic drug intake. Laboratory investigations revealed anemia with a hemoglobin of 8.4 gm/dl, neutrophilic leucocytosis and mild shift to left, 1 Department of Pathology, VMMC and Safdarjung Hospital, Safdar- jung, New Delhi, India 2 Laboratory, VMMC and Safdarjung Hospital, Safdarjung, New Delhi, India *Correspondence to: Oneal Gupta, M.B.B.S., D.C.P., D.N.B. (STD.), Sector III-A, H.NO.26, Ground Floor, Rachna Vaishali, Ghaziabad 201010, India. E-mail: oneal80@gmail.com Received 16 March 2011; Accepted 22 June 2011 DOI 10.1002/dc.21785 Published online in Wiley Online Library (wileyonlinelibrary.com). ' 2011 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 00, No 00 1