A fatal case of Lucio phenomenon in untreated Lucio leprosy
Keywords:
Acid-fast bacilli, Lucio leprosy, Lucio phenomenon, multi-drug therapy, necrosisAbstract
Lucio phenomenon (LP) is a rare and potentially fatal reaction that exclusively occurs in diffuse lepromatous leprosy or Lucio leprosy. It is characterized by purpuric macules, which progressively develop into extensive painful ulceration, primarily affecting the lower extremities. We report a case of 56-year-old with purpuric patches, blisters, and erosions on his face, mouth, arms, hands, legs, and feet that started to appear for three days without any hypopigmented or erythematous patches prior to the complaint. Slit skin smear examination revealed a bacterial index of 6+ with a morphological index of 13.66% and the Ziehl-Neelsen stains for acid fast bacili (AFB) were positive. He was diagnosed with LP complicating with sepsis. He was managed with multidrug therapy for multi-bacilary leprosy, corticosteroid, and antibiotic. However, his clinical condition was deteriorated and he died due to septic shock. Early recognition and prompt management are the key to successful therapy and preventing complications. Until now, there is no standard guideline for LP treatment due to its rare incidence. Multi-drug therapy for multibacillary leprosy is recommended for the management of LP. The use of corticosteroids and thalidomide is still controversial.References
Suzuki K, Akama T, Kawashima A. Current status of leprosy: Epidemiology, basic science, and clinical perspectives. J Dermatol. 2012;39:121-9.
Al Aboud K. Eponyms in leprology. Skinmed. 2010;8:323-6.
Jurado F, Rodriguez O, Novales J, Navarrete G, Rodriguez M. Lucio's leprosy: A clinical and therapeutic challenge. Clin Dermatol. 2015;33:66-78.
Frade MAC, Coltro PS, Filho FB, Horácio GS, Neto AA, da Silva VZ, et al. Lucio's phenomenon: A systematic literature review of definition, clinical features, histopathogenesis and management. Indian J Dermatol Venereol Leprol. 2021;13:1-14.
Choon SE, Tey KE. Lucio's phenomenon: a report of three cases seen in Johor, Malaysia. Int J Dermatol. 2009;48(9):984-8.
Marissa M, Rihatmadja R, Surya D, Lim H, Menaldi SL. Lucio's phenomenon: A report on six patients in a tertiary referral hospital in Indonesia. J Gen Proced Dermatol Venereol Indones. 2020:5(1);40-7.
Vargas-Ocampo F. Diffuse leprosy of Lucio and LatapÃ: A histologic study. Lepr Rev. 2007;78(3):248-60.
Peixoto AB, Portela PS, Leal FR, Brotas AM, Rodrigues NC. Lucio's phenomenon. Case study of an exceptional response to treatment exclusively with multibacillary multidrug therapy. An Bras Dermatol. 2013;88(6 Suppl 1):93-6.
Misra DP, Parida JR, Chowdhury AC, Pani KC, Kumari N, Krishnani N, et al. Lepra reaction with lucio phenomenon mimicking cutaneous vasculitis. Case Reports Immunol. 2014;2014:641989.