Lucio's Phenomenon. Case study of an exceptional response to treatment\nexclusively with multibacillary multidrug therapy
A sixty-three year old male patient informed the gradual appearance of painless\nhemorrhagic blisters on limbs, earlobes and torso one year ago. These lesions later\nregressed spontaneously, leaving only atrophic scars on their previous sites. He also\nreported several bouts of recurring sinusitis, hoarseness and progressive worsening of\nthe cutaneous lesions. This patient had a previous history of Chronic Obstructive\nPulmonary Disease (COPD), hyperuricemia and high blood pressure treated with an\nirregular use of nifedipine. He denied smoking, drinking or the use of illicit drugs and\nhe also had no family history of dermatologic diseases similar to his own. During\nadmission, the patient status was cachectic; he was dehydrated, asthenic, dyspneic and\nafebrile (). Physical examination showed\nan infiltrated face, with madarosis, besides ulceronecrotic geometrically shaped lesions\naffecting the limbs, torso and face. In some segments, these lesions would converge;\nleaving large denuded areas (). Neurologic\nexamination demonstrated bilaterally thickened fibular nerves, which were painless to\npalpation. Laboratory exams revealed anemia (hemoglobin: 9.5 g/dL; hematocrit: 29.9%;\nMVC: 76.5 fL), bandemia (10%), hypoproteinemia (5.1g/dL), and elevated levels of C\nreactive protein (CRP) and erythrocyte sedimentation rate (ESR) (27.4 mg/L and 82 mm/h\nrespectively); Anti-HIV, VDRL, Antinuclear Factor (ANF), Anti-DNA e anti-cardiolipin\nantibodies (ACA) were all negative. Skin smear bacilloscopy demonstrated a bacilloscopic\nlevel of 5 (i.e. the presence of an average of 100 to 1,000 bacilli per examined field).\nThe results of a biopsy on a forearm opened lesion showed an ulcerated epidermis,\naccompanied by a dense histiocitary infiltrate with peri-adnexal and interstitial\ndistribution; the presence of vascular fibrinoid necrosis with neutrophilic infiltrate\nand associated edema; also the presence of numerous granular bacilli by the Fite-Faraco\nstain, often arranged in a cluster-like formation (). The histopathological findings were compatible with the diagnosis of\nVirchowian hanseniasis, exhibiting Lucio's phenomenon reaction. Radiographies of the\nhands showed bone resorption on the right fifth digit; rhinoscopy visualized a nasal\nseptal perforation; a decrease of diameter in the glottic region was detected by the\nvideolaringoscopy; and the Mitsuda test was negative. The treatment of choice was\nexclusively with multibacillary multidrug therapy leading to a marked improvement in the\ncutaneous signs and symptoms after one month of use ().