Lucio phenomenon (LP) or erythema necroticans is a rare reaction pattern seen in untreated or partially treated lepromatous (LL) or borderline lepromatous (BL) leprosy cases. Necrotic Erythema Nodosum Leprosum (nENL), although seen in the same spectrum of leprosy, is seen in cases already undergoing treatment for leprosy and rarely in untreated cases. A 33-year-old male, a serving soldier presented to the medical clinic, in a remote area in the Northeast part of India with complaints of tender violaceous rash over previously normal looking skin, for 10 days along with myalgia and arthralgia, followed by low grade fever for 5 days. Cutaneous examination showed the presence of hyperpigmented to erythematous, irregularly shaped, discrete as well as coalescing purpuric macules and a few papules, with the presence of angular superficial ulcerations and haemorrhagic crusting, located over the trunk, abdomen, bilateral upper and lower extremities, including the palms and soles. He was started on systemic antibiotics by the physicians. Unfortunately, despite the treatment, the patient succumbed to the illness. A post-mortem biopsy sent from various parts of the body showed diffuse infiltration in the dermis with macrophages and lympho-histiocytic cells, numerous foam cells, panniculitis and necrotizing vasculitis. Fite-Faraco stain showed numerous cigar shaped bacilli arranged in the form of globi within macrophages. The cutaneous features were suggestive of LP, but the systemic features and histopathology favoured nENL, even though the patient had not been on any multibacillary therapy for leprosy, and showed no nodular eruptions preceding the haemorrhagic crusting.
BT - Leprosy Review DO - 10.47276/lr.94.2.176 IS - 2 LA - Eng M3 - Case report N2 -Lucio phenomenon (LP) or erythema necroticans is a rare reaction pattern seen in untreated or partially treated lepromatous (LL) or borderline lepromatous (BL) leprosy cases. Necrotic Erythema Nodosum Leprosum (nENL), although seen in the same spectrum of leprosy, is seen in cases already undergoing treatment for leprosy and rarely in untreated cases. A 33-year-old male, a serving soldier presented to the medical clinic, in a remote area in the Northeast part of India with complaints of tender violaceous rash over previously normal looking skin, for 10 days along with myalgia and arthralgia, followed by low grade fever for 5 days. Cutaneous examination showed the presence of hyperpigmented to erythematous, irregularly shaped, discrete as well as coalescing purpuric macules and a few papules, with the presence of angular superficial ulcerations and haemorrhagic crusting, located over the trunk, abdomen, bilateral upper and lower extremities, including the palms and soles. He was started on systemic antibiotics by the physicians. Unfortunately, despite the treatment, the patient succumbed to the illness. A post-mortem biopsy sent from various parts of the body showed diffuse infiltration in the dermis with macrophages and lympho-histiocytic cells, numerous foam cells, panniculitis and necrotizing vasculitis. Fite-Faraco stain showed numerous cigar shaped bacilli arranged in the form of globi within macrophages. The cutaneous features were suggestive of LP, but the systemic features and histopathology favoured nENL, even though the patient had not been on any multibacillary therapy for leprosy, and showed no nodular eruptions preceding the haemorrhagic crusting.
PB - Lepra PY - 2023 SP - 176 EP - 181 T2 - Leprosy Review TI - Lucio phenomenon or necrotic erythema nodosum leprosum in an untreated case of leprosy?? A diagnostic dilemma… UR - https://leprosyreview.org/article/94/2/20-22094 VL - 94 SN - 2162-8807 ER -