Fulminant manifestation of Lucio’s phenomenon in a patient with diffuse lepromatous leprosy

• Autores: Montiel Alfonso, Miguel Angel, Salomón Rivarola, María Belén, Oviedo Pintos, Gabriela Belem
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Universidad de San Martín de Porres
• Repositorio: Horizonte médico
• Lenguaje: español; inglés
• OAI Identifier: oai:horizontemedico.usmp.edu.pe:article/3873
• Enlace del recurso: https://horizontemedico.usmp.edu.pe/index.php/horizontemed/article/view/3873
• Nivel de acceso: acceso abierto
• Materia: Enfermedad de Hansen; Mycobacterium leprae; Lepra Lepromatosa; Enfermedades Infecciosas; Hansen Disease; Leprosy, Lepromatous; Infectious Diseases

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, characterized by a slow and progressive course. It may present with acute episodes of immune hyperreactivity, known as leprosy reactions, which are classified as type 1 and type 2, as well as Lucio’s phenomenon—a rare variant associated with diffuse lepromatous leprosy in untreated or irregularly treated patients, mediated by immune complexes that trigger severe vascular inflammation. We report the case of a 78-year-old male patient with a history of active smoking and long-standing diabetes mellitus who presented with disseminated, bilateral, and symmetrical dermatosis, predominantly involving the trunk and lower extremities. The lesions were characterized by erythematous-violaceous macules and plaques in a reticular pattern, some with purulent blisters, ulcers, and superinfection. Physical examination revealed leonine facies, bilateral auricular necrosis, and amputation of several toes on the left foot. Laboratory tests demonstrated a systemic inflammatory response, while skin biopsy revealed epidermal necrosis; macrophage-rich granulomas with neural and vascular involvement; leukocytoclastic vasculitis; and numerous acid-fast bacilli arranged in globi. A diagnosis of Lucio’s phenomenon was established, after which the WHO multibacillary regimen and prednisone were initiated. The patient subsequently developed sepsis secondary to cutaneous superinfection and community-acquired pneumonia, and ultimately died after 27 days of hospitalization.