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Lepra reactions are events with acute intense tissue damage in an otherwise chronic course of leprosy.
Type 2 lepra reaction can present with cutaneous features, classical lesions being erythema nodosum
leprosum (ENL) and its variants, and/or rheumatological features with polyarthralgia and arthritis
along with systemic involvement. The ulceronecrotic variant of ENL is a marker of severe reaction and
can mimic other etiologies of cutaneous vasculitides. We present a case of a young female presenting
with diffuse scarring ulcers with severe constitutional symptoms, raised cytoplasmic-antineutrophil
cytoplasmic antibodies (c-ANCA), mimicking necrotizing vasculitis in the absence of overt cutaneous
features of leprosy, later diagnosed as ENL necroticans by a slit skin smear.