IntroductionLeprosy, also known as Hansen’s disease, is an infamous chronic granulomatous infection caused by Mycobacterium leprae and Mycobacterium lepromatosis . These pathogens predominantly affect the skin and peripheral nerves. Although leprosy is known to have been eradicated in many parts of the world, it remains a major concern in developing countries, including India. Lepra reactions are immunological reactions that can complicate the course of the disease and can be a significant burden to the patient, irrespective of the status of multidrug therapy. That is, these reactions can occur before, during or after the completion of multidrug therapy [1].Lepra reactions can manifest in two types: type 1 and type 2 reactions. Type 1 reactions, also known as reversal reactions, are characterized by the development of acute inflammatory changes in skin lesions with or without neuritis, and it usually affects borderline forms of leprosy. Type 2 reactions, often referred to as erythema nodosum leprosum (ENL), typically present with constitutional symptoms, accompanied by crops of painful, erythematous, cutaneous nodules or plaques, with patients frequently experiencing multiple episodes. This type of reaction is commonly associated with lepromatous type of leprosy. ENL lesions are usually managed with the use of prednisone and thalidomide [2].While ENL typically presents with tender erythematous nodules, instances of atypical presentations of ENL such as vesiculo-bullous lesions (46% of atypical presentations), ulcero-necrotic lesions (41%), erythema multiforme-like lesions (28%), Sweet’s syndrome-like lesions (11%) and pustules (9%) are rarely found in the annals of medical literature [3]. Recently, we encountered an unusual case of bullous ENL. This article offers a comprehensive account of this distinctive presentation.