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

Abstract

BackgroundLucio’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 presentationA 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.ConclusionThough 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.

Identification ofMycobacterium lepraeandMycobacterium lepromatosisin Formalin-Fixed and Paraffin-Embedded Skin Samples from Mexico

“…However as it has been observed in another papers DLL is related only with M. lepromtosis alone or with dual infection, but not only with M. leprae, it could explain the severity of these cases 13 . Finally, these findings add evidence to the M. leprae and M. lepromatous distribution and clinical forms in the Mexican territory, and may aid to clarify the Lucio's phenomenon etiological agent 20,21 .…”

Diffuse Necrotic Ulcerations Revealing Lepromatous Leprosy with Lucio's Phenomenon

“…Lucio's phenomenon or Lucio reaction is a severe form of lepra reaction type 2. Initially described in Mexico, it has rarely been reported in Africa [3,4]. As observed in our case, it affects patients with diffuse lepromatous leprosy without nodules and begins clinically with erythematous spots of limbs leading to bulla, epidermal necrosis and ulceration [2].…”

“…In a Brazilian cohort, five of the 12 cases were male with an age range from 27 to 67 years old; death occurred in four cases indicating that lethality is not uncommon in LP. Additional cases were reported from India and Sri Lanka [4][5][6].…”

Perfil clínico e epidemiológico de pacientes em reação hansênica

“…Leprosy is a chronic disease caused by Mycobacterium leprae and has a clinical course depending on the interaction between the host immune response and this pathogen, which predominantly infects the skin and peripheral nerve cells, leading to lesions at these sites (1)(2) . The degree of immunity of individuals determines the clinical form of the disease, which can be classified as indeterminate, tuberculoid, borderline, lepromatous or pure neural, with variations between dermatological and neurological damage in each of these classifications (2) .…”