Lucio Phenomenon: A Rare Type of Leprosy Reaction

  • Frieda Department of Dematology and Venerology, Faculty of Medicine Universitas Sebelas Maret Surakarta/ Public General Hospital dr. Moewardi Surakarta, Indonesia.
  • Harijono Kariosentono Department of Dematology and Venerology, Faculty of Medicine Universitas Sebelas Maret Surakarta/ Public General Hospital dr. Moewardi Surakarta, Indonesia.
  • Endra Yustin Ellistasari Department of Dematology and Venerology, Faculty of Medicine Universitas Sebelas Maret Surakarta/ Public General Hospital dr. Moewardi Surakarta, Indonesia.
Keywords: Leprosy Reaction, Lucio Phenomenon, Morbus Hansen

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.

How to cite this article:
Frieda, Kariosentono H, Ellistasari EY. Lucio Phenomenon: A Rare Type of Leprosy Reaction. Special Issue - COVID-19 & Other Communicable Disease. 2022;253-257.

DOI: https://doi.org/10.24321/0019.5138.202238

References

Hungria EM, Bührer-Sékula S, de Oliveira RM, Aderaldo LC, Pontes AA, Cruz R, Gonçalves HS, Penna ML, Penna GO, Stefani MM. Leprosy reactions: the predictive value of mycobacterium leprae-specific serology evaluated in a Brazilian cohort of leprosy patients (U-MDT/CT-BR). PLoS Negl Trop Dis. 2017 Feb;11(2):e0005396. [PubMed] [Google Scholar]

Wolff K, Johnson RA, Saavedra AP, Roh EK. Fitzpatrick’s color atlas and synopsis of clinical dermatology. 8th ed. United States: McGraw-Hill Education; 2017. [Google Scholar]

World Health Organization (WHO) [Internet]. Leprosy (Hansen’s disease); 2021 [cited 2021 Aug 31]. Available from: https://www.who.int/news-room/fact-sheets/detail/leprosy

Permenkes RI. Peraturan Menteri Kesehatan Republik Indonesia nomor 11 Tahun 2019 tentang Penanggulangan Kusta. PMK. 2019;11:19-20. Indonesian.

Leon KE, Salinas JL, McDonald RW, Sheth AN, Fairley JK. Case report: complex type 2 reactions in three patients with hansen’s disease from a southern United States clinic. Am J Trop Med Hyg. 2015 Nov;93(5):1082-6. [PubMed] [Google Scholar]

Fabel A, Brunasso AM, Schettini AP, Cota C, Puntoni M, Nunzi E, Biondo G, Cerroni L, Massone C. Pathogenesis of leprosy: an insight into B lymphocytes and plasma cells. Am J Dermatopathol. 2019 Jun;41(6):422-7. [PubMed] [Google Scholar]

Nery JA da C, Bernardes Filho F, Quintanilha J, Machado AM, Oliveira S de SC, Sales AM. Understanding the type 1 reactional state for early diagnosis and treatment: a way to avoid disability in leprosy. An Bras Dermatol. 2013 Sep-Oct;88(5):787-92. [PubMed] [Google Scholar]

Scollard DM, Martelli CM, Stefani MM, Maroja Mde F, Villahermosa L, Pardillo F, Tamang KB. Risk factors for leprosy reactions in three endemic countries. Am J Trop Med Hyg. 2015 Jan;92(1):108-14. [PubMed] [Google Scholar]

Rocha RH, Emerich PS, Diniz LM, De Oliveira MBB, Cabral ANF, Do Amaral ACV. Lucio’s phenomenon: Exuberant case report and review of Brazilian cases. An Bras Dermatol. 2016 Sep-Oct;91(5):60-3. [PubMed] [Google Scholar]

Curi PF, Villaroel JS, Migliore N, Albertengo A, Aquino ML, Ceccato F, Paira S. Lucio’s phenomenon: report of five cases. Clin Rheumatol. 2016 May;35(5):1397-401. [PubMed] [Google Scholar]

Lockwood DNJ. Leprosy. In: Rook’s Textbook of Dermatology. 9th ed. John Wiley & Sons, Inc; 2016.

Vieira AP, Trindade MÂ, Pagliari C, Avancini J, Sakai-Valente NY, da Silva Duarte AJ, Benard G. Development of type 2, but not type 1, leprosy reactions is associated with a severe reduction of circulating and in situ regulatory T-cells. Am J Trop Med Hyg. 2016 Apr;94(4):721-7. [PubMed] [Google Scholar]

Shah UH, Jadwani MM, Raju SP, Ladani PH, Bhuptani NV. Clinical and histopathological features in lepra reaction: a study of 50 cases. Int J Res Dermat. 2019;5(2):382.

Bilik L, Demir B, Cicek D. Leprosy reactions. In: Hansen’s disease the forgotten and neglected disease. IntechOpen; 2019;13.

Ramal C, Casapia M, Marin J, Celis JC, Baldeon J, Cubas G, Espejo A. Diffuse Multibacillary Leprosy of Lucio and Latapí with Lucio’s Phenomenon, Peru. Emerg Infect Dis. 2017;23(11):1929-1930.

Fogagnolo L, de Souza EM, Cintra ML, Velho PENF. Vasculonecrotic reactions in leprosy. Brazilian J Infect Dis. 2007 Jun;11(3):378-82. [PubMed] [Google Scholar]

Lemus-Barrios GA, Hoyos-Pulgarín JA, Jimenez-Canizales CE, Hidalgo-Zambrano DM, Escobar-Montealegre F, Mondragon-Cardona A, Medina-Morales DA. Lucio’s phenomenon: a report of two cases and review of the literature. Case Reports Intern Med. 2019;6(2):15. [Google Scholar]

Magana M. Lucio phenomenon. In: Leprosy - a practical guide. Nunzy E, Massone C, editors. Springer; 2012;241-4.

Marissa M, Rihatmadja R, Surya D, Lim H, Menaldi S. Lucio’s phenomenon: a report on six patients in a tertiary referral hospital in Indonesia. J Gen Dermatology Venereol Indones. 2020;5(1):40-7. [Google Scholar]

Published
2022-03-16