IgA Nephropathy in Hansen’s Disease with Bizarre Reaction Pattern: A Clinical Uncertainty

Hansen’s disease is a chronic infectious disease with varied systemic manifestations. Renal involvement is well recognized in Hansen’s disease; however, biopsy-proven primary IgA nephropathy is exceptionally rare. Most reported IgA-associated glomerular lesions in leprosy represent IgA-dominant infection-related glomerulonephritis rather than primary IgA nephropathy. Only isolated biopsy-proven cases have been reported, underscoring the rarity of the present case. We report a 40-year-old man with lepromatous leprosy complicated by IgA nephropathy, whose clinical course was further aggravated by a bizarre noduloulcerative erythema nodosum leprosum (ENL) reaction following treatment non-adherence. This case emphasizes the importance of routine renal screening, multidisciplinary management, and strict treatment adherence in multibacillary leprosy.