Erythema nodosum leprosum in a general hospital

We report 32 patients with erythema nodosum leprosum (ENL). Twenty-two patients developed ENL before beginning chemotherapy. The recognition that ENL in the absence of chemotherapy is not an uncommon event is of importance, not simply as a fact in and of itself, but because this observation raises provocative questions when placed in the context of current ideas concerning ENL. ENL should be regarded as a manifestation of leprosy, not necessarily as a complication of its therapy.