Disseminated tuberculosis in association with erythema nodosum leprosum

Mycobacterial diseases are endemic in India but simultaneous occurrence of tuberculosis and leprosy is rarely reported. We report a case of disseminated tuberculosis in an immunocompromised host due long-standing unsupervised corticosteroid intake with erythema nodosum leprosum (type 2 lepra reaction). The patient presented with generalized erythematous papulonodular skin lesions with malaise and body ache for the past 2 years. Later, he developed fever and testicular pain for which he sought medical advice. The diagnosis was based on the various laboratory and imaging studies supported by demonstration of Mycobacterium tuberculosis and Mycobacterium leprae in sputum and skin smears, respectively. The patient developed hepatitis which led to management challenges, however, the institution of antitubercular and antileprosy therapy in titrating doses resulted in improvement of the patient's condition.