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. 2013 Mar;58(2):160.
doi: 10.4103/0019-5154.108087.

Is it Lucio Phenomenon or Necrotic Erythema Nodosum Leprosum?

Pss Ranugha  1 , Laxmisha Chandrashekar, Rashmi Kumari, Devinder M Thappa, Bhawana Badhe
Affiliations

Is it Lucio Phenomenon or Necrotic Erythema Nodosum Leprosum?

Pss Ranugha et al. Indian J Dermatol. 2013 Mar.

Abstract

Lucio phenomenon (LP) or erythema necroticans is a relatively rare, peculiar reaction pattern occurring in untreated lepromatous (LL) or borderline lepromatous (BL) leprosy cases. A 38-year-old male, a cook by occupation, was referred to the dermatology clinic from otolaryngology department with blistering over both the hands and feet of 2 days duration. He had been admitted 1 week back with epistaxis and nasopharyngeal myiasis in otolaryngology department. He was started on systemic antibiotics gentamycin, crystalline penicillin, and metronidazole with nasal instillation of turpentine oil 2 drops 6 times a day. Two days later, he had developed edema with painless hemorrhagic blistering over the dorsum of left hand followed by involvement of the right hand, dorsa of both feet, and both the earlobes within a day. Histopathology of the blister showed sub-epidermal blister, with necrotizing leukocytoclastic vasculitis of papillary dermal vessels with thrombosis, numerous acid-fast bacilli in macrophages, and macrophage granulomas extending up to subcutis. In view of the absent fever or constitutional symptoms, and the classical angular infarcts and hemorrhagic blisters evolving into ulcers with angulated margins, we considered LP as the most likely diagnosis. The patient was started on a combination of WHO recommended multibacillary anti-leprosy therapy and prednisolone (40 mg/day).

Keywords: Lucio phenomenon; necrotic erythema nodosum leprosum; vasculitis.

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Conflict of interest statement

Conflict of Interest: Nil.

Figures

Figure 1
Figure 1
(a) Hemorrhagic blisters and purpuric macules over dorsum of both the feet (b) Clear fluid filled vesicles and hemorrhagic crusting present along the rim of the right ear
Figure 2
Figure 2
(a) Atrophic epidermis, thin Grenz zone and diffuse macrophage granulomas in the upper dermis (H and E, stain at ×40 magnification). (b) Papillary dermal vessels showing evidence of leukocytoclastic vasculitis (H, and E stain at ×40 magnification)
Figure 3
Figure 3
Healing ulcers two and a half months after starting therapy
See this image and copyright information in PMC

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