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

Peixoto, Amanda Braga; Portela, Poliana Santin; Leal, Fabiano; Brotas, Arles Martins; Rodrigues, Nilton Carlos dos Santos

doi:10.1590/abd1806-4841.20132398

Cited by 9 publications

(7 citation statements)

References 2 publications

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“…As shown in chart 1 , despite the scarcity of published cases, it is clear that LP represents a severe reaction with significant mortality rates, mostly associated with pregnancy and secondary infection. 2 , 4 , 8 , 9 , 10 MDT-MB was the most common treatment, but we identified differences in the association or not of other medicines with the treatment. There is no consensus on the histopathology of LP.…”

Section: Discussionmentioning

confidence: 79%

“…The syndrome is almost exclusively limited to Mexican and Central American patients, although it is rarely reported in Cuba, South America, the United States, India, Polynesia, South Africa and Southeast Asia. 2 It is characterized by painful, slightly infiltrated, erythematous macules outbreaks and hemorrhagic blisters that develop with central necrosis and ulceration. 4 …”

Section: Discussionmentioning

confidence: 99%

“…Lucio’s phenomenon (LP) is an uncommon reaction characterized by severe necrotizing cutaneous lesions that occur in patients with Lucio’s leprosy and lepromatous leprosy (LL). 2 It is considered by some authors as a variant of type 2 or 3 reaction. Although Brazil has the world’s second highest incidence of leprosy (33,303 cases), few cases of LP are reported in the Brazilian literature.…”

Section: Introductionmentioning

confidence: 99%

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Lucio's phenomenon: exuberant case report and review of Brazilian cases

Rocha

Emerich

Diniz

et al. 2016

An. Bras. Dermatol.

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Lucio’s phenomenon is an uncommon reaction characterized by severe necrotizing cutaneous lesions that occurs in patients with Lucio’s leprosy and lepromatous leprosy. It is considered by some authors as a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs and pregnancy. We report a 31-year-old female patient exhibiting both clinical and histopathological features of lepromatous leprosy and Lucio’s phenomenon presenting favorable response to treatment. We complement our report with a literature review of the Brazilian cases of Lucio’s phenomenon published in Portuguese and English.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lucio's phenomenon: exuberant case report and review of Brazilian cases

Rocha

Emerich

Diniz

et al. 2016

An. Bras. Dermatol.

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“…Although rare, Lucio's phenomenon has also been reported among other forms of lepromatous leprosy (6). Multidrug therapy (MDT) is currently the treatment recommended by the World Health Organization for all forms of leprosy, including DLL and Lucio's phenomenon (14,15). Until recently, Mycobacterium leprae was considered the sole causative agent of all forms of leprosy, including Lucio's phenomenon,…”

mentioning

confidence: 99%

Insight into the evolution and origin of leprosy bacilli from the genome sequence of Mycobacterium lepromatosis

Singh

Benjak

Schuenemann

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

136

135

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Mycobacterium lepromatosis is an uncultured human pathogen associated with diffuse lepromatous leprosy and a reactional state known as Lucio's phenomenon. By using deep sequencing with and without DNA enrichment, we obtained the near-complete genome sequence of M. lepromatosis present in a skin biopsy from a Mexican patient, and compared it with that of Mycobacterium leprae, which has undergone extensive reductive evolution. The genomes display extensive synteny and are similar in size (∼3.27 Mb). Protein-coding genes share 93% nucleotide sequence identity, whereas pseudogenes are only 82% identical. The events that led to pseudogenization of 50% of the genome likely occurred before divergence from their most recent common ancestor (MRCA), and both M. lepromatosis and M. leprae have since accumulated new pseudogenes or acquired specific deletions. Functional comparisons suggest that M. lepromatosis has lost several enzymes required for amino acid synthesis whereas M. leprae has a defective heme pathway. M. lepromatosis has retained all functions required to infect the Schwann cells of the peripheral nervous system and therefore may also be neuropathogenic. A phylogeographic survey of 227 leprosy biopsies by differential PCR revealed that 221 contained M. leprae whereas only six, all from Mexico, harbored M. lepromatosis. Phylogenetic comparisons indicate that M. lepromatosis is closer than M. leprae to the MRCA, and a Bayesian dating analysis suggests that they diverged from their MRCA approximately 13.9 Mya. Thus, despite their ancient separation, the two leprosy bacilli are remarkably conserved and still cause similar pathologic conditions. Mycobacterium lepromatosis | genome sequencing | Mycobacterium leprae | comparative genomics | reductive evolution

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“…The pure form of Lucio’s may only necessitate the usual multi drug regimen. Thus making the usual anti-leprosy drugs an effective first line treatment [ 15 ] without requiring thalidomide or systemic corticosteroids to be included into the regimen [ 6 , 27 ], though these have also been opted to be used in severe situations and found useful [ 21 ]. However, fatality has been seen despite aggressive treatment [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Lucio’s phenomenon, an uncommon occurrence among leprosy patients in Sri Lanka

et al. 2015

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BackgroundLucio’s phenomenon is a rare manifestation of untreated leprosy which is seen almost exclusively in regions surrounding the Gulf of Mexico. Its occurrence elsewhere though documented is considered uncommon. We present a case of Lucio’s phenomenon in a previously undiagnosed leprosy patient who presented to us with its classical skin manifestations.Case presentationA 64 year old South Asian (Sri Lankan) male with a history of chronic obstructive airway disease presented to us with fever and cough. He had a generalized smooth and shiny skin with ulcerating skin lesions afflicting the digits of the fingers. The lesions progressed to involve the extremities of the body and healed with crusting. Based on the clinical and investigational findings Tuberculosis and common vasculitic conditions were suspected and excluded. The unusual skin manifestations prompted a biopsy, and wade fite stained revealed Mycobacterium bacilli. In context of the clinical picture and histological findings, Lucio’s phenomenon was suspected. A clinical diagnosis of Lucio’s phenomenon occurring in the backdrop of lepromatous leprosy was made.ConclusionThough leprosy is still a prevalent disease, it has manifestations that are not easily recognized or fully appreciated. Regional patterns of atypical manifestations should not limit better understanding of rarer manifestations as it will aid in clinching an early diagnosis and instituting prompt treatment, thereby reducing morbidity and mortality.

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

Cited by 9 publications

References 2 publications

Lucio's phenomenon: exuberant case report and review of Brazilian cases

Lucio's phenomenon: exuberant case report and review of Brazilian cases

Insight into the evolution and origin of leprosy bacilli from the genome sequence of Mycobacterium lepromatosis

Lucio’s phenomenon, an uncommon occurrence among leprosy patients in Sri Lanka

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