Lucio's phenomenon: exuberant case report and review of Brazilian cases

Abstract

Lucio's phenomenon is an uncommon reaction characterized by severe necrotizing cutaneous lesions that occurs in patients with Lucio's leprosy and lepromatous leprosy. It is considered by some authors as a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs and pregnancy. We report a 31-year-old female patient exhibiting both clinical and histopathological features of lepromatous leprosy and Lucio's phenomenon presenting favorable response to treatment. We complement our report with a literature review of the Brazilian cases of Lucio's phenomenon published in Portuguese and English.

Figure 1

A and B) bilateral necrosis on the left and right buttocks, respectively. C) necrosis on the right knee. D) Necrosis on the right elbow

Figure 2

A) Necrosis of the right ear B) Traduzir para: B) Necrosis and tendon exposure on the left leg

Figure 3

A) Inflammatory infiltrate affecting the dermis and hypodermis (Hematoxylin - eosin, x40). B) Perivascular lymphohistiocytic infiltrate with multiple Virchow’s cells (see arrows)(Hematoxylin - eosin, x100). C) Thrombosis of vessels in the hypodermis (see circles)(Hematoxylin - eosin, x100). D) Endothelial proliferation with occlusion of the vessel lumen (see circle), (Hematoxylin - eosin, x100)

Figure 4

Numerous bacilli on the lumen and vessel wall invading endothelial cells. BAAR 6/6+ globi 3/3+. Ziehl Neelsen coloring (Hematoxylineosin, x400)

Figure 5

Improvement of lesions on the A) right knee and B) right elbow - 45 days after the start of the treatment