Lepra Reactions

A 38-year-old man with borderline lepromatous leprosy on multidrug therapy for 6 months presents with acute onset fever, painful nodules on extensor surfaces, and neuritis. Laboratory findings show elevated ESR and CRP. All of the following are features of Erythema Nodosum Leprosum (ENL) EXCEPT:

A 32-year-old man from rural Maharashtra, diagnosed with lepromatous leprosy 8 months ago, presents with acute onset of painful nodules and plaques on his face, trunk, and extremities over the past 3 days. He also reports fever (38.5°C), malaise, and tender nodules. His treatment compliance has been excellent. On examination, the existing leprotic lesions appear inflamed. Slit-skin smear shows numerous acid-fast bacilli. What is the most likely diagnosis?

A 38-year-old man with lepromatous leprosy on anti-leprosy therapy for 3 months presents with acute onset fever, painful nodules on extensor surfaces, and neuritis. Histology shows neutrophilic infiltrate with immune complex deposition. All of the following are features of Type 2 lepra reaction (Erythema Nodosum Leprosum) EXCEPT:

A 28-year-old woman from Odisha with borderline tuberculoid (BT) leprosy presents with sudden onset of pain and swelling in the left ulnar and posterior tibial nerves. She has developed new anesthetic patches on the dorsal surface of her left hand and lateral aspect of her left foot over the past 2 weeks. She is on MDT for 3 months. On examination, there is marked nerve thickening and tenderness. Skin smear microscopy shows 2+ acid-fast bacilli. What is the most likely diagnosis?

A 42-year-old woman with borderline tuberculoid leprosy develops acute inflammation of existing lesions with pain and swelling 2 months into MDT. Histology shows epithelioid cell granulomas with few bacilli. Which drug is the preferred treatment for this lepra reaction?