For refractory ENL, small clinical experiences report benefits from anti-TNF biologics, such as infliximab, including an NEJM case and subsequent series; however, pharmacovigilance and systematic reviews note a risk signal for leprosy occurring under anti TNF-α therapy, necessitating careful selection and monitoring (Faber et al., 2006; Cogen et al., 2020; Mendes et al., 2022). This evidence concerns the gene TNF and leprosy.