Lucio's phenomenon, an uncommon occurrence among leprosy patients in Sri Lanka

Abstract

Background: Lucio's phenomenon is a rare manifestation of untreated leprosy which is seen almost exclusively in regions surrounding the Gulf of Mexico. Its occurrence elsewhere though documented is considered uncommon. We present a case of Lucio's phenomenon in a previously undiagnosed leprosy patient who presented to us with its classical skin manifestations.

Case presentation: A 64 year old South Asian (Sri Lankan) male with a history of chronic obstructive airway disease presented to us with fever and cough. He had a generalized smooth and shiny skin with ulcerating skin lesions afflicting the digits of the fingers. The lesions progressed to involve the extremities of the body and healed with crusting. Based on the clinical and investigational findings Tuberculosis and common vasculitic conditions were suspected and excluded. The unusual skin manifestations prompted a biopsy, and wade fite stained revealed Mycobacterium bacilli. In context of the clinical picture and histological findings, Lucio's phenomenon was suspected. A clinical diagnosis of Lucio's phenomenon occurring in the backdrop of lepromatous leprosy was made.

Conclusion: Though leprosy is still a prevalent disease, it has manifestations that are not easily recognized or fully appreciated. Regional patterns of atypical manifestations should not limit better understanding of rarer manifestations as it will aid in clinching an early diagnosis and instituting prompt treatment, thereby reducing morbidity and mortality.

Fig. 1

Skin manifestations of Lucio’s phenomenon observed. The first row depicts, bizarre shaped well demarcated superficial ulceration with slough formation (left image), which following treatment resulted in healing with cicatrization (middle and right images) The second row shows large denuded areas secondary to ulceration and necrosis of the foot (left and middle) finally resolving with cicatrization (right image). The third row depicts symmetrical involvement of the lower limbs (left) and upper limbs (right) with extensive bizarre ulceronecrosis. The fourth row depicts diffuse facial involvement with shiny skin, madarosis and infiltration with nodules in the chin (left) with involvement of the ear with necrotic lesions associated with crusting (middle) and mild truncal involvement with hairless shiny skin (right)

Fig. 2

Histology of the skin biopsy. Image (1) depicts wade fite stain demonstrating the presence of (red) bacilli (indicated by arrow) within foamy cells and endothelial cells. Image (2) demonstrates blood vessels (indicated by arrow) with associated endothelial swelling. Image (3) shows presence of necrosis and ulceration of epidermis without panniculitis. Image (4) depicts endothelial proliferation and capillary thrombosis (indicated by arrow)