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

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.

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

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.

Case Report: Rapid Response to Low-Dose Thalidomide in a Case of Severe Steroid Recalcitrant Erythema Nodosum Leprosum

2021 ◽  
Author(s):  
B. Savitha ◽  
Kabir Sardana ◽  
Ritu Kumari ◽  
Ananta Khurana ◽  
Surabhi Sinha ◽  
...  
Keyword(s):  
Low Dose ◽  
Erythema Nodosum ◽  
Lepromatous Leprosy ◽  
High Dose ◽  
Effective Treatment Option ◽  
Steroid Dependence ◽  
Erythema Nodosum Leprosum ◽  
Organ Specific ◽  
Inflammatory Drugs

Erythema nodosum leprosum (ENL), or type 2 lepra reaction, presents with crops of evanescent, tender erythematous nodules accompanied by fever, arthralgia, weight loss, malaise, and organ-specific manifestations, and is seen in borderline and lepromatous leprosy. The drugs approved for ENL include nonsteroidal anti-inflammatory drugs, systemic steroids, thalidomide, and clofazimine. The management of ENL is challenging because long-term steroid use leads to steroid dependence. Our patient had severe steroid recalcitrant ENL with vesicular and pustular lesions mimicking Sweet’s syndrome, and was treated effectively with a low-dose thalidomide regimen (100 mg/d) as opposed to the high dose (400 mg/d) recommended in the literature. We discuss the patho-mechanics and clinical utility of a low-dose thalidomide regimen as an effective treatment option for ENL.

Lucio Phenomenon: A Rare Manifestation of Leprosy in Selangor, Malaysia

2021 ◽  
Vol 5 (0-2) ◽  
pp. 20
Author(s):  
Shahrizan Majid Binti Allapitchai
Keyword(s):  
Peripheral Nerves ◽  
Histopathological Examination ◽  
Skin Condition ◽  
Lepromatous Leprosy ◽  
Lower Limbs ◽  
Who Guidelines ◽  
Rare Manifestation ◽  
Hands And Feet ◽  
Multiple Ulcers ◽  
Made In

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, predominantly affecting the skin and peripheral nerves. Lucio phenomenon is a rare reactional state presenting in patient with lepromatous leprosy and described as acute cutaneous necrotising vasculitis. We discussed the case of a 38-year-old male patient presenting with oedematous and dusky discolouration of bilateral hands and feet associated with diffuse facial involvement. His skin condition gradually worsened to form multiple ulcers with bizarre shaped purpuric lesion over bilateral upper and lower limbs, trunk, and face. Histopathological examination of the skin biopsy showed multiple acid-fast bacilli and diagnosis of Lucio’s phenomenon was made in the background of lepromatous leprosy. He was treated with multi drug therapy (MDT) as recommended by the WHO guidelines. A better understanding of rarer manifestation of this illness is important for early diagnosis and to prevent significant morbidity associated with it.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S20

scholarly journals A case of concomitant subcorneal pustular dermatosis and erythema nodosum leprosum in borderline lepromatous leprosy-relapses

2017 ◽  
Vol 4 (4) ◽  
pp. 6
Author(s):  
Hendra Gunawan ◽  
Nina Roslina ◽  
Oki Suwarsa
Keyword(s):  
Erythema Nodosum ◽  
Histopathological Examination ◽  
Lepromatous Leprosy ◽  
Erythema Nodosum Leprosum ◽  
Subcorneal Pustular Dermatosis ◽  
Morphological Index ◽  
The Face ◽  
History Of ◽  
Chronic Course ◽  
Bacterial Index

Subcorneal pustular dermatosis (SPD) is a rare, chronic, and recurrent pustular eruption characterized histopathologically by subcorneal pustules that contain neutrophils. SPD has been clearly reported conjunction with other diseases. Leprosy reactions are acute inflammatory process that immunologically driven on the chronic course of leprosy. Erythema nodosum leprosum (ENL) is a type II of leprosy reaction putatively can initiate SPD lesions. We report one case of concomitant SPD and ENL in borderline lepromatous leprosy-relapses. A 41-year-old man with the history of using multidrug therapy-multibacillary for leprosy presented with painful erythematous nodules on the trunk and extremities, accompanied by pustules on erythematous base on the face, arms, buttocks, and legs. There were thickening of both ulnar nerves with gloves and stocking hypesthesia. The bacterial index was 3+ and morphological index was 20\%. Histopathological examination on the pustule revealed subcorneal pustules with exocytosis of neutrophils which supported the diagnosis of SPD. A possible immunologic mechanism has been suggested in the induction of the occurence both SPD and ENL.

Correlation of euglobulin immunoglobulin G levels with erythema nodosum leprosum in lepromatous leprosy

1977 ◽  
Vol 8 (2) ◽  
pp. 335-344 ◽  
Author(s):  
Morris Reichlin ◽  
Robert A. Pranis ◽  
Robert H. Gelber ◽  
R.J.W. Rees ◽  
Janice Taverne ◽  
...  
Keyword(s):  
Immunoglobulin G ◽  
Erythema Nodosum ◽  
Lepromatous Leprosy ◽  
Erythema Nodosum Leprosum

Lepromatous leprosy in erythema nodosum leprosum reaction mimicking Sweet’s syndrome

2011 ◽  
Vol 50 (9) ◽  
pp. 1124-1125 ◽  
Author(s):  
Yee-Kiat Heng ◽  
Yuun-Tirng Lynn Chiam ◽  
Yoke-Chin Giam ◽  
Wei-Sheng Chong
Keyword(s):  
Erythema Nodosum ◽  
Lepromatous Leprosy ◽  
Sweet’S Syndrome ◽  
Sweet's Syndrome ◽  
Erythema Nodosum Leprosum

Clofazimine (lamprene) in leprosy

1970 ◽  
Vol 8 (2) ◽  
pp. 7-8
Keyword(s):  
Complex Disease ◽  
Erythema Nodosum ◽  
Lepromatous Leprosy ◽  
Mycobacterium Ulcerans ◽  
Cell Mediated Immunity ◽  
Drug Reactions ◽  
Immune Complex Disease ◽  
Erythema Nodosum Leprosum ◽  
Anti Inflammatory ◽  
Line Drug

Clofazimine (Lamprene - Geigy), a fat-soluble, orange dye with both anti-mycobacterial and anti-inflammatory properties,1 is now being advocated as the main second-line drug in the treatment of leprosy. It has been recommended for patients with any type of leprosy who develop serious drug reactions (e.g. haemolytic anaemia or hepatitis) to dapsone, and for long-treated lepromatous patients in whom the organisms have become sulphone-resistant. These two complications are uncommon, but because of its anti-inflammatory properties clofazimine has also been recommended in the treatment of ‘lepra reactions’, which are inflammatory episodes that frequently complicate lepromatous leprosy.2 There are two main types: (a) erythema nodosum leprosum (ENL), an immune-complex disease3 which may develop in about half of all treated lepromatous patients; (b) lepra reactions associated with changes in cell-mediated immunity2 4 which may occur in both treated and untreated patients in many types of leprosy. Clofazimine may also be the best drug for tropical ulcers due to Mycobacterium ulcerans infection.5

scholarly journals Lucio's phenomenon: another case reported in Brazil

2012 ◽  
Vol 87 (2) ◽  
pp. 296-300 ◽  
Author(s):  
Rodrigo Monteiro ◽  
Marcelo Guimarães Tiezzi ◽  
Marilda Aparecida Milanez Morgado de Abreu ◽  
Claudia Cardoso Macedo de Oliveira ◽  
Eduardo Vinícios Mendes Roncada ◽  
...  
Keyword(s):  
Rare Event ◽  
Lepromatous Leprosy ◽  
Coagulation System ◽  
Multidrug Therapy ◽  
Tissue Necrosis ◽  
Inflammatory Reactions ◽  
Vascular Lumen ◽  
Endothelial Proliferation ◽  
Lucio’S Phenomenon

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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