Lucio phenomenon mimicking antiphospholipid syndrome: The occurrence of antiphospholipid antibodies in a leprosy patient

Abstract

Lucio phenomenon is an atypical reaction of leprosy, characterized by vasculitic lesions that can mimic antiphospholipid syndrome (APS) clinically. Distinguishing the two can be difficult as antiphospholipid autoantibodies may be present in patients with leprosy. We report on a 32‐year‐old female patient presenting with a sudden onset of fever, hemorrhagic bullae, and skin necrosis on her lower legs. She was treated for APS due to the presence of antiphospholipid antibodies but had an inadequate response. A skin biopsy revealed thrombotic vasculopathy and necrotizing vasculitis associated with aggregation of foam cells in the perivascular area and subcutis, with acid‐fast bacilli in the histiocytes and blood vessel walls. Direct immunofluorescence showed IgM, C3, and fibrinogen deposition in the superficial and deep dermal blood vessels. The pathology confirmed the diagnosis of Lucio phenomenon, and appropriate therapy was given. It is essential to evaluate the patient comprehensively, including clinical, serological, and pathological aspects, to obtain the correct diagnosis.

Diagnosis and Treatment of Leprosy in Taiwan during the COVID-19 Pandemic: A Retrospective Study in a Tertiaty Center

“…AFS showed numerous bacilli within the specimens [10]. In a type III reaction, necrotic vessel walls with perivascular infiltration and nuclear dust were observed, along with lobular panniculitis with globi [9]. Numerous acid-fast bacilli were found in endothelial cells and associated with vasculitis.…”

“…Approximately 18% (n = 5) of our patients had type I reactions (Figure 1), three had type II, and one had type III. Of these, one 32-year-old woman from Indonesia experienced a type III reaction that presented with erythematous swelling patches and hemorrhagic bullae on the bilateral lower legs, feet, and toes, a condition known as the Lucio phenomenon [9]. Intermittent fever was noted during the treatment course.…”

Challenging in leprosy relapse with antiphospholipid syndrome diagnosis: A case report

“…This is vital for implementing appropriate therapy and influencing patient prognosis. 12,13 Guevara et al 13 represented a patient exhibiting acute fever, lower extremity skin necrosis, and hemorrhagic bullae. Initial laboratory assessments demonstrated positive results for aPL antibodies, prompting treatment initiation with hydroxychloroquine and systemic corticosteroids under a presumptive APS diagnosis.…”

“…The clinical presentation of Lucio's phenomenon possesses similarities to those observed in APS, necessitating its consideration as a differential diagnosis where clinical features overlap. This is vital for implementing appropriate therapy and influencing patient prognosis 12,13 …”

“…Guevara et al 13 . represented a patient exhibiting acute fever, lower extremity skin necrosis, and hemorrhagic bullae.…”