Mareen Jacob, Madhukara Jithendriya
Department of Dermatology, St. Johns Medical College, Bangalore, Karnataka, India.
Indian Dermatol Online J. 2016 Sep-Oct;7(5):406-409. doi: 10.4103/2229-5178.190498.
Lucio phenomenon (LP) or erythema necroticans is a rare type of reaction pattern found in untreated patients with diffuse non-nodular leprosy. It is important to distinguish this from vasculonecrotic erythema nodosum because thalidomide with high-dose steroids is the mainstay of treatment for the latter, whereas LP shows no response to thalidomide. We report a case of a 60-year-old man who presented with purpuric patches, hemorrhagic blisters, and ulcers over extremities of 15 days duration. On cutaneous examination, there were multiple stellate purpuric patches, hemorrhagic bullae, and deep necrotic ulcers, mainly over extremities. Slit-skin smear examination from six sites revealed bacteriological index 6+ with globi, and morphological index 5%. Histopathology revealed diffuse infiltration of bacilli in epidermis, dermis, and endothelial cells along with neutrophilic and lymphocytic infiltrate. Fibrinoid necrosis and thrombosis of blood vessels was also noted. The above clinicohistopathological features helped in making the diagnosis of LP. Concomitantly he was found to be infected with hepatitis C virus. Many triggering factors have been described in literature; however, activation of hepatitis C as a trigger for Lucio phenomenon has not been reported. In addition, IgM and IgG anticardiolipin antibodies were found to be positive. The patient was started on high-dose steroids along with multibacillary antileprosy therapy and improved within 2 weeks.
卢西奥现象（LP）或坏死性红斑是在未经治疗的弥漫性非结节性麻风患者中发现的一种罕见反应模式。将其与血管坏死性结节性红斑区分开来很重要，因为沙利度胺联合高剂量类固醇是后者的主要治疗方法，而LP对沙利度胺无反应。我们报告一例60岁男性患者，其四肢出现紫癜性斑块、出血性水疱和溃疡，病程15天。皮肤检查发现多处星状紫癜性斑块、出血性大疱和深部坏死性溃疡，主要位于四肢。六个部位的皮肤涂片检查显示细菌学指数为6+，有麻风球，形态学指数为5%。组织病理学显示表皮、真皮和内皮细胞中有杆菌弥漫性浸润，伴有中性粒细胞和淋巴细胞浸润。还发现了血管的纤维蛋白样坏死和血栓形成。上述临床组织病理学特征有助于诊断LP。同时发现他感染了丙型肝炎病毒。文献中描述了许多触发因素；然而，丙型肝炎激活作为卢西奥现象的触发因素尚未见报道。此外，发现IgM和IgG抗心磷脂抗体呈阳性。患者开始接受高剂量类固醇治疗并联合多菌型抗麻风治疗，2周内病情好转。
