[2 cases of Lucio phenomenon in Paraguay]

Lucio's phenomenon: a report of three cases seen in Johor, Malaysia

BACKGROUND

Lucio's phenomenon is a rare and aggressive necrotising variant of erythema nodosum leprosum that classically occur in patients with undiagnosed, diffuse non-nodular lepromatous leprosy. It is a potentially fatal leprosy reaction characterised by extensive, bizarrely-shaped, painful purpuric skin lesions and ulcerations. Lucio's phenomenon is very rarely reported outside of Mexico and Costa Rica.

METHODS

We describe 3 cases seen in Johor, Malaysia.

RESULTS

The first two cases responded to the prompt simultaneous institution of daily rifampicin, dapsone, clofazimine and prednisolone. Case 3 continued to have new lesions and extension of existing lesions while on dapsone and clofazimine. The subsequent addition of rifampicin and prednisolone prevented new lesion formation but patient succumbed to the extensive cutaneous infarcts and consequent sepsis.

CONCLUSIONS

Early diagnosis and prompt institution of multi-drug therapy together with prednisolone may improve the prognosis and outcome of Lucio's phenomenon.

Lucio's phenomenon/erythema necroticans

Lucio's phenomenon/erythema necroticans is a peculiar reaction pattern that occurs in untreated pure primitive diffuse lepromatous leprosy (PPDL) and/or relapsing leprosy recognized as spotted leprosy of Lucio. The small number of reported cases in the world literature suggests that it is fairly uncommon. Its clinical features are fairly characteristic and consist of extensive, bizarre, painful ulcerations of the skin, with constitutional symptoms being conspicuous by their absence. The clinical diagnosis is confirmed by microscopic pathology marked by proliferation and mobilization of polyblasts and histiocytes, dilatation, endothelial proliferation, luminal occlusion, and thrombosis of the superficial and mid-dermal blood vessels and demonstration of acid-fast bacilli in the blood vessel walls. Its precise pathogenesis is still unclear, but is believed to occur either through the usual or the alternate pathway of complement activation in the natural history of erythema nodosum leprosum. The clinical and immunological features of reactions in leprosy, including erythema nodosum leprosum, are well known and have been critically evaluated elsewhere.