Lepra reaction with lucio phenomenon mimicking cutaneous vasculitis.

Durga Prasanna Misra,Vikas Agarwal,Jyoti Ranjan Parida,Narendra Krishnani,Abhra Chandra Chowdhury,Niraj Kumari,Krushna Chandra Pani

doi:10.1155/2014/641989

Abstract

Leprosy is a disease typically found in the tropics. Patients with leprosy can have varying presentation with constitutional symptoms, joint pains, skin nodules, and rarely a vasculitis-like picture with skin ulcers and neuropathy. We present a young lady who presented with the rare manifestation of skin infarcts mimicking cutaneous vasculitis, diagnosed on histopathology to have Lucio phenomenon on a background of lepromatous leprosy. With increasing migration and widespread use of biologic response modifiers, clinicians all over the world need to be aware of various presentations of leprosy as well as needing to keep an open mind while considering the differential diagnoses of vasculitis.

Highlights

Leprosy refers to systemic infection caused by Mycobacterium leprae, or less commonly Mycobacterium lepromatosis
We present a young lady who presented with large cutaneous infarcts that on the first impression were vasculitic but were subsequently proven to be due to Lucio phenomenon in the context of lepromatous leprosy
Type I lepra reaction occurs on a background of tuberculoid leprosy, where cell-mediated immunity is robust, and is characterized by inflammation occurring inside existing skin lesions as well as appearance of new nodules and skin infiltrates

Summary

Introduction

Leprosy refers to systemic infection caused by Mycobacterium leprae, or less commonly Mycobacterium lepromatosis. Endemic to the tropics, it is increasingly being found in developed countries outside of the tropical regions [1, 2], predominantly due to activation of latent infection in the context of immunosuppression with biologic response modifiers This serves as a reminder of the global importance of this problem at a time when boundaries are shrinking [3] and widespread use of biologics is becoming the norm rather than the exception in the treatment of many immune-mediated diseases, including ankylosing spondylitis and rheumatoid arthritis. Patients with leprosy can present with symptoms varying from constitutional to arthralgias and arthritis, mononeuritis multiplex, or frank lepra reactions [4, 5] These can mimic a wide variety of common conditions including rheumatoid arthritis, lupus, and vasculitis [6]. We present a young lady who presented with large cutaneous infarcts that on the first impression were vasculitic but were subsequently proven to be due to Lucio phenomenon in the context of lepromatous leprosy

Case Presentation

Discussion