Patel Nayankumar Harshadkumar, Padhiyar Jignaben Krunal, Patel Kathak Ashok, Patel Jahnvi Rakeshkumar, Lakum Megha Pratapabhai, Singh Itu
GCS Medical College Hospital and Research Centre, Ahmedabad, India.
Stanley Browne Laboratory, TLM Community Hospital, Nand Nagari, Delhi, India.
Access Microbiol. 2023 Oct 20;5(10). doi: 10.1099/acmi.0.000460.v3. eCollection 2023.
The Lucio phenomenon (LP) is a characteristic reaction pattern seen in patients with diffuse lepromatous leprosy (DLL). Dual infection with and in DLL has been confirmed from other endemic countries but not previously documented from India. Conventionally, LP is treated with a high dose of systemic glucocorticoid (GC) and anti-leprosy treatment (ALT). Here we report a case of leprosy lymphadenitis at initial presentation in a patient with LP and DLL due to dual infection with and who responded favourably to tofacitinib as adjuvant to ALT and systemic GC therapy.
A 20- to 30-year-old man presented with swelling over the bilateral inguinal region, pus-filled skin lesions with multiple ulcers, fever and joint pain. Post-hospitalization investigations showed the presence of anaemia, leukocytosis, and elevated acute and chronic inflammatory markers. Skin and lymph node biopsies were suggestive of LP and leprosy lymphadenitis. The presence of and was confirmed by PCR followed by DNA sequencing of PCR amplicons from tissue. Despite anti-leprosy treatment, oral GC and thalidomide therapy, the patient continued to develop new lesions. One month after the commencement of adjuvant tofacitinib, the patient showed excellent clinical improvement with healing of all existing lesions and cessation of new LP lesions.
Our case confirms the presence of dual infection with and in India. Lymph node involvement as an initial presentation of DLL should be considered in endemic areas. Tofacitinib may be a promising new adjuvant therapy for recalcitrant lepra reactions.
卢西奥现象（LP）是弥漫性瘤型麻风（DLL）患者中出现的一种特征性反应模式。在其他麻风流行国家已证实DLL患者存在 和 的双重感染，但此前印度尚无相关记录。传统上，LP采用高剂量全身性糖皮质激素（GC）和抗麻风治疗（ALT）。在此，我们报告1例因 和 双重感染导致LP和DLL的患者，其初诊时表现为麻风性淋巴结炎，该患者接受托法替布作为ALT和全身性GC治疗的辅助药物后反应良好。
一名20至30岁男性，双侧腹股沟区肿胀，有多个溃疡的脓性皮肤病变，伴有发热和关节疼痛。住院后检查显示存在贫血、白细胞增多以及急性和慢性炎症标志物升高。皮肤和淋巴结活检提示为LP和麻风性淋巴结炎。通过PCR及对组织PCR扩增产物进行DNA测序，证实存在 和 。尽管接受了抗麻风治疗、口服GC和沙利度胺治疗，但患者仍不断出现新病变。在开始使用托法替布辅助治疗1个月后，患者临床症状显著改善，所有现有病变愈合，新的LP病变停止出现。
我们的病例证实了印度存在 和 的双重感染。在流行地区，应考虑将淋巴结受累作为DLL的初发表现。托法替布可能是一种有前景的治疗顽固性麻风反应的新辅助疗法。
