Lucio’s phenomenon, a mutilating manifestation of leprosy

摘要

A 44-year-old man was referred to our hospital with purple spots on his skin seven days prior. Dermatological examination revealed macules, erythematous violaceous papules, hemorrhagic blisters, and ulcerations with a clean background in the legs, feets, and hands were observed. No comorbidities or use of medications was noted. A similar episode occurred two years ago, in which the fifth left pododactyl was amputated. During hospitalization, he developed necrotic areas in his right toes (Figure 1). Laboratory test results were as follows: anti-cardiolipin IgG, 24.7 (positive: 20 GLP); IgM, 150 (positive: 20 MPL), antinuclear factor positive 1:160; and mixed standard, fine dotted nuclear, homogeneous nucleolar, and spindle-type mitotic patterns were observed. Histopathological examination revealed diffuse histiocytic infiltrate; a foamy appearance; several alcohol-acid-resistant bacilli in Ziehl-Neelsen's stain, sometimes in the wall and inside the vessel; and presence of erythrodiapedesis and eosinophils (vasculitis) (Figure 2). However, the other tests did not change. The diagnosis was lepromatous leprosy, suggesting Lucio’s phenomenon (LF). After starting the specific treatment, there was a significant improvement in the lesions and elimination of necrotic areas in three weeks (Figure 3). The patient was discharged from the hospital and was followed up as an outpatient.