Type 2 lepra reaction is a Th2-mediated type III hypersensitivity reaction in leprosy, with a characteristic cutaneous manifestation in the form of erythema nodosum leprosum (ENL). Chronic ENL is described as recurrent or persistent nodules existing for more than 6 months’ duration. Reaction hand manifests with oedema of the dorsum of the hands, arthritis, and functional incapacity during type 2 lepra reaction. The diagnosis of ENL is quite challenging because of its heterogeneous clinical presentations and prolonged incubation period. A 36-year-old female developed recurrent painful nodules with fever all over the body two years ago. She was also treated for rheumatoid arthritis 7 years back. She was subsequently treated with steroids, clofazimine, and thalidomide. A 19-year-old male presented with a recurrent history of fever, joint pain, and erythematous painful nodules over extremities after completing a course of MDT (Multi Drug Therapy). He was on treatment with steroids, due to which he developed avascular necrosis of the left hip joint and was later shifted to thalidomide. A 45-year-old female having completed 2 years of MDT developed erythema and oedema of palms and soles with myalgia for which she was given steroids, methotrexate, and clofazimine thrice daily. A 27-year-old male having completed the course of MDT developed swelling and pain in his fingers, for which he was treated with steroids, hydroxychloroquine, and methotrexate. We report these four cases due to the unusual manifestations of type 2 lepra reactions, such as chronic ENL and reaction hand. © 2025 Elsevier B.V., All rights reserved.