Lucio Phenomenon: A Rare Type of Leprosy Reaction

Abstract

Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae (M. leprae), which affects the skin and peripheral nerves. Lucio phenomenon is a rare leprosy reaction characterized by severe necrotizing skin lesions. This case report aims to provide clinicians with more information regarding the rare Lucio phenomenon. Case: A 53-year-old male patient presented with worsening lesions on both lower limbs. Physical examination revealed bilateral madarosis and saddle nose. Multiple erythematous lesions with deep ulceration, multiple necrotic tissues, and bilateral extremities deformities were found. There were amputations of the right hand’s digits III and V and left hand’s digits V. Decreased sensory function was found in the median, ulnar and posterior tibial nerves. Acid-fast bacilli (AFB) staining revealed bacterial index (BI) +3 and morphological index (MI) 10%. Histopathological examination showed foamy macrophages, leukocytoclastic vasculitis, lobular panniculitis, and diffuse multiple perivascular infiltrates. It also had extensive areas of necrosis with diffuse neutrophil infiltrate in the deep layer of the dermis and the globes in macrophages. The patient was diagnosed with the Lucio phenomenon and given treatment in the form of Multi-Drug Therapy (MDT) for its multibacillary leprosy, corticosteroids, antibiotics, and wound care. The patient died on the 18th day of treatment. Conclusion: Early detection is necessary to start the treatment immediately and prevent disease worsening. Although MDT and corticosteroid treatment effectively ameliorates the lesions of the Lucio phenomenon, this patient had extensive skin and nerve involvement, secondary infection, and anemia. These resulted in a poor prognosis and increased morbidity.