Erythema nodosum leprosum (ENL) occurs in patients with high bacterial loads of leprosy and more than 50 percent of patients have this complication within the first year of effective antileprosy treatment. In a patient with lepromatous leprosy with an ENL reaction, Ga-67 imaging revealed multiple patchy accumulations of tracer in the skin of the face, trunk, arms, and thighs. Tc-99m HMPAO labeled WBC imaging showed no abnormal uptake in those areas. We learned from this case that Ga-67 imaging could detect inflammatory changes of an ENL reaction of leprosy. Tc-99m HMPAO labeled WBC imaging does not appear to be useful in this application.