Clinico-histopathological correlation in 3 patients with Lucio phenomenon: A serial case report
Keywords:Lucio Phenomenon, histopathology, leprosy, manifestation, characteristic
AbstractLucio Phenomenon (LPh) is a reactional state usually observed in untreated or inadequately treated leprosy and is a life-threatening medical emergency. Several cases of LPh have been reported in Indonesia, which is an endemic country with highest burden of new case besides India and Brazil. Generally, histopathological findings in LPh reveal granulomatous and panniculitis reactions with vascular infiltration of acid fast bacilli. However, it is still debatable whether the main pathophysiology of necrosis is due to occlusive vasculopathy or immune complex-mediated process. In this study, we report clinical and histopathological descriptions of 3 patients with LPh. The first case was resulted with severe necrosis, mortality and massive bacilli infiltration with endothelial damage on histopathology examination. The second and third case presented less severe manifestation with multiple ulcers covered with hemorrhagic crust and mild necrosis. The histopathology examination showed minimal inflammation on the endothelial. This serial case report showed that histopathological examination might be useful as a prediction value on LPh since it can characterize the basic pathogenesis process. Lucio Phenomenon (LPh) is a reactionary state usually observed in untreated or inadequately treated leprosy and is a life-threatening medical emergency.
Vargas-Ocampo F. Diffuse leprosy of Lucio and Latapí: a histologic study. Leprosy review 2007; 78 (3): 248–60. doi: 18035776.
Frade MAC, Coltro PS, Filho FB et al. Lucio’s phenomenon: A systematic literature review of definition, clinical features, histopathogenesis and management. Indian Journal of Dermatology, Venereology and Leprology 2021; 88 464. doi: 10.25259/IJDVL_909_19.
Rea TH, Jerskey RS. Clinical and histologic variations among thirty patients with Lucio’s phenomenon and pure and primitive diffuse lepromatosis (Latapi’s lepromatosis). International journal of leprosy and other mycobacterial diseases : official organ of the International Leprosy Association 2005; 73 (3): 169–88.
Marissa M, Rihatmadja R, Surya D et al. Lucio’s phenomenon: A report on six patients in a tertiary referral hospital in Indonesia. Journal of General-Procedural Dermatology and Venereology Indonesia 2020; 5 (1): 40–47. doi: 10.19100/jdvi.v5i1.225.
Jurado F, Rodriguez O, Novales J et al. Lucio’s leprosy: A clinical and therapeutic challenge. Clinics in Dermatology 2015; 33 (1): 66–78. doi: 10.1016/j.clindermatol.2014.07.004.
Nath I, Chaduvula M (2017) Immunological Aspects. In: IAL Textb. Lepr. Jaypee Brothers Medical Publishers, p 144.
Ramesh V, Kataria KJ. Systemic Involvement and Special Situations of Leprosy. In: Kumar B, Kar KH (eds) IAL Textb. Lepr. The Health Sciences Publisher 2017; pp 331–332.
Han XY, Sizer KC, Velarde-Félix JS et al. The leprosy agents Mycobacterium lepromatosis and Mycobacterium leprae in Mexico. International Journal of Dermatology 2012; 51 (8): 952–959. doi: 10.1111/j.1365-4632.2011.05414.x.
Scollard DM. Association of Mycobacterium Leprae with Human Endothelial Cells In Vitro. Laboratory Investigation 2000; 80 (5): 663–669. doi: 10.1038/labinvest.3780069.
Magaña M, Fernández-Díez J, Magaña ML. Lucio’s Phenomenon Is a Necrotizing Panvasculitis: Mostly a Medium-Sized Granulomatous Arteritis. The American Journal of Dermatopathology 2008; 30 (6): 555–560. doi: 10.1097/DAD.0b013e318181270a.
Benard G, Sakai-Valente NY, Bianconcini Trindade MA. Concomitant Lucio Phenomenon and Erythema Nodosum in a Leprosy Patient: Clues for Their Distinct Pathogeneses. The American Journal of Dermatopathology 2009; 31 (3): 288–292. doi: 10.1097/DAD.0b013e318193c74c.