Lucio's phenomenon: another case reported in Brazil

Lucio's phenomenon is defined as a variant of type 2 leprosy reaction. It is a rare event, occurring in the evolution of leprosy of Lucio and other forms of lepromatous leprosy. It has an exacerbated proliferation of Hansen bacilli in its pathophysiology, which invade blood vessel walls and injure endothelial cells, causing endothelial proliferation and decreasing the vascular lumen. This fact, associated with inflammatory reactions and changes in the coagulation system causes vascular thrombosis, ischemia, infarction and tissue necrosis, leading to the histopathological characteristic of the phenomenon. We report a case of lepromatous leprosy with irregular treatment that developed Lucio's phenomenon. Treatment with multidrug therapy, antibiotics, steroids and thalidomide achieved a favorable outcome.

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Lucio Phenomenon mimicking with Vasculo necrotic Erithema Nodosum Leprosum: A Case Report

International Journal of PharmTech Research ◽

10.20902/ijptr.2019.130321 ◽

2020 ◽

Vol 13 (3) ◽

pp. 288-294

Author(s):

Dwi Sepfourteen ◽

Tutty Ariani

Keyword(s):

Endothelial Cell ◽

Erythema Nodosum ◽

Lepromatous Leprosy ◽

Lower Limbs ◽

Acid Fast Bacilli ◽

Erythema Nodosum Leprosum ◽

Endothelial Proliferation ◽

Hands And Feet ◽

Epidermal Necrosis ◽

Lucio’S Phenomenon

Clinical features of Lucio’s phenomenon (LP), shows a nectorizing erythema, may mimicking Erythema Nodosum leprosum with vasculonecrotic. A 46 years old man presented with diagnosis lepromatous leprosy with Lucio’s phenomenon and diferential diagnosis borderline lepromatous (BL) with vasculonecrotic erithema nodosum leprosum. The patients complained there were painless ulcers on his lower limbs and scrotum, with surrounded by purpuric patches which subsequently became gangrenes and ulcerated for 3 weeks. There was numbness of both hands and feet, the eyelashes, eyebrows baldness since 5 years ago. Patient never got the treatment before. Bacteriological examination showed bacterial index 6+ Histopathology: there were Flattened epidermis by narrow grenz zone, and lymphocyte in perivascular with macrophage. There was endothelial proliferation of capiller. Fite faraco stain showed macrophage infiltration around the perivasculer, with colonization of the endothelial cell by acid fast bacilli and epidermal necrosis and diagnosis as Lepromatous leprosy with Lucio phenomenon. This patient is given adult multiple drug therapy (MDT) therapy, methylprednisolone, neurotrophic vitamins. Lucio’s phenomenon most commonly affects patients with untreated leprosy. Clinically, it may be difficult to differentiate Lucio phenomenon from Erythema nodosum leprosum with vasculonecrotic. In this case, the histopathological examination were colonization of endothelial cell by acid fast bacilli, epidermal necrosis and endothelial proliferation of the vessel.

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Cutaneous ulceration as a presenting feature of type 1 lepra reaction: A case report

Tropical Doctor ◽

10.1177/00494755211068661 ◽

2022 ◽

pp. 004947552110686

Author(s):

Pallavi Hegde ◽

Deepti Jaiswal ◽

Varsha M Shetty ◽

Kanthilatha Pai ◽

Raghavendra Rao

Keyword(s):

Case Report ◽

Erythema Nodosum ◽

Immunological Response ◽

Lepromatous Leprosy ◽

Multidrug Therapy ◽

Cutaneous Lesions ◽

Erythema Nodosum Leprosum

Reactions in leprosy represent sudden shift in the immunological response and are seen in 11–25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT). 1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.

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Lucio's Phenomenon. Case study of an exceptional response to treatment exclusively with multibacillary multidrug therapy

Anais Brasileiros de Dermatologia ◽

10.1590/abd1806-4841.20132398 ◽

2013 ◽

Vol 88 (6 suppl 1) ◽

pp. 93-96 ◽

Cited By ~ 3

Author(s):

Amanda Braga Peixoto ◽

Poliana Santin Portela ◽

Fabiano Roberto Pereira de Carvalho Leal ◽

Arles Martins Brotas ◽

Nilton Carlos dos Santos Rodrigues

Keyword(s):

Weight Loss ◽

Male Patient ◽

Lepromatous Leprosy ◽

Response To Treatment ◽

Multidrug Therapy ◽

Cutaneous Lesions ◽

Histopathological Findings ◽

Lucio’S Phenomenon

Lucio's phenomenon represents a serious cutaneous necrotizing reaction, which can occur with Lucio's leprosy and also in other forms of lepromatous leprosy. The authors discuss the case of a 63-year-old male patient presenting with ulcers and necrotic cutaneous lesions on the limbs, torso and face, associated with recurring sinusitis, hoarseness and a weight loss of 25 kilos over the last year. Bacilloscopy of intradermal scrapings showed a bacilloscopic index of 5 and the histopathological findings were compatible with the diagnosis of Lucio's phenomenon. The chosen treatment was exclusively multibacillary multidrug therapy, resulting in important dermatological improvement after one month of therapy. The authors present an impressive case of Lucio's phenomenon with an exceptional response to treatment exclusively with multibacillary multidrug therapy.

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Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

Tropical Doctor ◽

10.1177/0049475521998499 ◽

2021 ◽

pp. 004947552199849

Author(s):

Prakriti Shukla ◽

Kiran Preet Malhotra ◽

Parul Verma ◽

Swastika Suvirya ◽

Abir Saraswat ◽

...

Keyword(s):

Erythema Nodosum ◽

Case Series ◽

Lepromatous Leprosy ◽

Sweet Syndrome ◽

Erythema Nodosum Leprosum ◽

Leprosy Patients ◽

Atypical Presentations ◽

Neuropathic Ulcers

Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley–Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes – spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.

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Primary herpetic oropharyngitis in adults: Differences in clinical features between Herpes simplex virus type 1 and type 2. A retrospective study.

10.22541/au.162108672.25641799/v1 ◽

2021 ◽

Author(s):

Hideki Nakagawa ◽

Toshiyuki Kusuyama ◽

Makoto Miyamoto ◽

Koichiro Saito ◽

Shunya Ikeda

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Specific Antigen ◽

Oral Lesions ◽

Inflammatory Reactions ◽

Key Points ◽

Low Incidence ◽

Simplex Virus

Key points 1. This is the first report of adult primary herpetic oropharyngitis in the view point of the differences between the two types of herpes simplex virus (HSV). 2. 41 (25 type 1 and 16 type 2) HSV specific antigen positive cases among 68 immunoserologically confirmed adult HSV primary infection cases were investigated. 3. Significantly low incidence of oral lesions and high incidence of nausea were seen in HSV type 2 oropharyngitis cases, that might mean particular correlation vagus nerve and HSV type 2. 4. Significantly increased white blood cell count and high C-reacative protein value were seen in oropharyngitis by HSV type 2. 5. HSV type 2 possibly cause more severe symptoms and higher inflammatory reactions than type 1, without oral lesions.

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Significance of the Differential Peptidome in Multidrug-Resistant Tuberculosis

BioMed Research International ◽

10.1155/2019/5653424 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12

Author(s):

Yan Yang ◽

Jianqing Wu

Keyword(s):

Multidrug Resistant ◽

Fold Change ◽

Differentially Expressed ◽

Coagulation System ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Precursor Proteins ◽

Canonical Pathways ◽

Mdr Tb

Most multidrug-resistant tuberculosis (MDR-TB) patients fail to receive a timely diagnosis and treatment. Therefore, we explored the differentially expressed peptides in MDR-TB compared with drug-susceptible tuberculosis (DS-TB) patients using LC-MS/MS and Ingenuity Pathway Analysis (IPA) to analyse the potential significance of these differentially expressed peptides. A total of 301 peptides were differentially expressed between MDR-TB and DS-TB groups. Of these, 24 and 16 peptides exhibited presented high (fold change ≥ 2.0, P < 0.05) and low (fold change ≤ −2.0, P < 0.05) levels in MDR-TB. Significant canonical pathways included the prothrombin activation system, coagulation system, and complement system. In the network of differentially expressed precursor proteins, lipopolysaccharide (LPS) regulates many precursor proteins, including four proteins correlated with organism survival. These four important differentially expressed proteins are prothrombin (F2), complement receptor type 2 (CR2), collagen alpha-2(V) chain (COL5A2), and inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4). After addition of CR2 peptide, IL-6 mRNA expression in THP-1 cells decreased significantly in dose- and time-dependent manners. Cumulatively, our study proposes potential biomarkers for MDR-TB diagnosis and enables a better understanding of the pathogenesis of MDR-TB. The functions of differentially expressed peptides, especially CR2, in MDR-TB require further investigation.

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Lepromatous leprosy with Lucio's phenomenon

Australasian Journal of Dermatology ◽

10.1111/ajd.12639 ◽

2017 ◽

Vol 59 (1) ◽

pp. 62-63

Author(s):

Yan-Fei Wang ◽

Ping Wang ◽

Hui Huang

Keyword(s):

Lepromatous Leprosy ◽

Lucio’S Phenomenon

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Lepromatous leprosy masquerading as rhinophyma

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20150585 ◽

2015 ◽

Vol 1 (1) ◽

pp. 34

Author(s):

Sowmyashree Krishna ◽

Malcolm Pinto ◽

Manjunath Mala Shenoy ◽

Mahesh SG

Keyword(s):

Infectious Disease ◽

Global Health ◽

Health Problem ◽

Mycobacterium Leprae ◽

Lepromatous Leprosy ◽

The Body ◽

Multidrug Therapy ◽

Diagnostic Challenge ◽

Cervical Lymphadenitis ◽

Global Health Problem

<p>Leprosy a major global health problem, especially in the developing world, is an infectious disease caused by <em>Mycobacterium leprae</em>. Leprosy has a predilection to with cooler areas of the body. Lepromatous leprosy presents with varied manifestations like nodules, cervical lymphadenitis, hyperpigmented patches and other presentations which can mimic various other diseases and pose a diagnostic challenge in endemic areas. We report a case presenting with nodular infiltration of the nose mimicking rhinophyma who presented with faint reddish swelling over the nose which progressed to nodular infiltration. There was bilateral symmetrical thickening of nerves following which diagnosis was confirmed by slit skin smear and the patient was started on multibacillary multidrug therapy. The importance of rightly diagnosing cases presenting as nodules that mimic rhinophyma is important because of the infectious nature of the disease which pose a threat to the community.</p>

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Optic nerve involvement in a borderline lepromatous leprosy patient on multidrug therapy

Leprosy Review ◽

10.47276/lr.84.4.316 ◽

2013 ◽

Vol 84 (4) ◽

pp. 316-321

Author(s):

Neel Prabha ◽

Vikram K. Mahajan ◽

Surinder K. Sharma ◽

Vikas Sharma ◽

Pushpinder S. Chauhan ◽

...

Keyword(s):

Optic Nerve ◽

Lepromatous Leprosy ◽

Leprosy Patient ◽

Multidrug Therapy ◽

Nerve Involvement ◽

Optic Nerve Involvement

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Leprosy Reactions: Clinical and Therapeutic Profile of Patients Registered at a Dermatology Reference Center in Brazil

International Archives of Medicine ◽

10.3823/2534 ◽

2017 ◽

Vol 10 ◽

Author(s):

Danielle Oliveira De Sousa ◽

Karolyne Moura Rique De Oliveira ◽

Deborah Marques Centeno ◽

Carolina Ribeiro Mainardi ◽

Jean Carlos Alves de Lima Souza ◽

...

Keyword(s):

Metropolitan Region ◽

Multidrug Therapy ◽

Inclusion Criteria ◽

Neural Damage ◽

Leprosy Reactions ◽

Protective Sensation ◽

The City ◽

Therapeutic Profile

Introduction: During the course of leprosy, 10 to 50% of individuals can be surprised by reaction states, which are immune system reactions of the patient to Mycobacterium leprae. Leprosy reactions constitute the main cause of nerve damage and disability caused by leprosy. Objective:To analyze the clinical and therapeutic profile of patients with leprosy reactions registered in a Dermatology Service in the city of Belém-PA. Methods:This is a cross-seccional, descriptive study. It was investigated through analysis of medical records, 52 patients who fit the established inclusion criteria. Data were collected in july and august 2016. Results: It was found a predominance of men, from the metropolitan region. The clinical form most common of Leprosy was Borderline, and the leprosy reaction type 1. The most of reactions occurred right after the introduction of multidrug therapy,and more than a half of patients with type 1 reaction showed edema of limbs. Regarding the type 2, fever and general symptoms were the most common, present in all cases. The frequency of neural damage was evident, showing reduction of motor force level andloss of protective sensation. Conclusion: Early diagnosis and appropriate therapeutic management of reactive events is critical to the prevention of disabilities.

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