Diagnosis: Leprosy Lucio's phenomenon
Description: Ulcers on lower leg
Morphology: Ulcer
Site: Leg
Sex: M
Age: 41
Type: Clinical
Submitted By: Ian McColl
Differential Diagnosis
History:
Patient of Dr J Lim
| 41 years old man with no known comorbids came with multiple ulcerations over his lower limbs for more than 6 months. Ulcers first started from the feet then extended upwards to involve his feet.
Despite his extensive ulcerations, he is actually quite well and did not seem to be of much pain when dressing / undressing his wound. There were extensive demarcated, some jagged ulceration and has multiple necrotic scabs over his bilateral feet and leg. Apart from his obvious problem of ulcers, he has a glistening face with purpuric patch with necrotic scab over his pinna and nasal area. He also has loss of eyebrow with pinna and the eyebrow region appearing infiltrated. Skin biopsy showed leukocytoclastic vasculitis with numerous AFBs invading blood vessels. Slit Skin smear is also positive.
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Lucio phenomenon is a rarer type of immune reaction occuring when lepromatous leprosy is treated. The commoner presentation of the type 2 reaction is erythema nodosum leprosum with erythema nodosum like lesions scattered over a larger body area than the shins but Lucio's is a vasculitis of small vessels giving the lesions we see here today. |