Erythema nodosum leprosum presenting as vesiculopustular lesions as initial manifestation of leprosy caused by Mycobacterium leprae is of rare occurrence and is very sparsely reported. We present a case of 24-year-old man with complaint of fever, inguinal lymphadenopathy, and vesiculopustular lesions over extremities and trunk. Slit skin smear from lesions showed acid-fast bacilli. Histopathological examination of the skin biopsy revealed granuloma with acid-fast bacilli. Patient was managed conservatively with multidrug therapy along with steroids and thalidomide and improved during hospital stay. Erythema nodosum leprosum expressing as initial manifestation of leprosy in form of vesiculopustular lesions is needed to be enlisted along with the other differential diagnosis presenting similarly.
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