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      Fenómeno de Lucio. A propósito de un caso Translated title: Lucio´s phenomenon. About a case

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          Abstract

          RESUMEN El fenómeno de Lucio es un estado reaccional grave, poco frecuente, mediado por inmunocomplejos que se observa típicamente en los casos de lepra lepromatosa difusa. En Paraguay, corresponde aproximadamente al 2% de los casos de lepra diagnosticados en la mayoría de los casos, se presenta como debut de la enfermedad. Se manifiesta con lesiones en la piel de tipo máculas y placas purpúricas poligonales, generalmente sin compromiso visceral. El diagnóstico lo confirma el estudio histopatológico y es fundamental realizar el diagnóstico diferencial con vasculitis de otras etiologías.

          Translated abstract

          ABSTRACT Lucio's phenomenon is a rare and severe reactional state mediated by immune complexes that is commonly seen in cases of diffuse lepromatous leprosy. In Paraguay, it represents approximately 2% of leprosy diagnosed cases, mainly as a debut of the disease. It manifests with macule-type skin lesions and polygonal purpuric plaques, generally without visceral involvement. The diagnosis is confirmed by the histopathological study and it is essential to consider differential diagnosis such as vasculitis of other etiologies.

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          Lucio's phenomenon: A systematic literature review of definition, clinical features, histopathogenesis and management.

          Leprosy is a chronic disease with clinical presentations according to the immunologic spectrum. Lepromatous form is the most advanced, with the highest transmissibility and risk of causing disabilities. Lucio's phenomenon is a rare manifestation among lepromatous patients with a rapid and severe evolution and high mortality. It is difficult to differentiate from ulcerative/necrotic erythema nodosum leprosum and has no consensus on how it should be treated. This article is a qualitative review of the literature after the introduction of multidrug therapy, aiming to bring consensus related to the clinical, laboratory and histopathological diagnostic criteria of the disease and its management.
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            Lucio's leprosy: a clinical and therapeutic challenge.

            Leprosy has been a challenge in different areas of medicine; in underdeveloped countries it remains a public health problem, in which the social and economic problems facilitate the disease persistence. The diagnosis and consequently the treatment are delayed due to the clinical polymorphism of leprosy, which especially at the beginning the manifestations are not as evident, as is the case of diffuse lepromatous leprosy. This favors the disabilities and the development of the reaction episodes. Fortunately, reaction episodes have decreased with the use of multidrug therapy, and better control of the type 2 reactions has been managed with the use of thalidomide, as in Lucio's phenomenon.
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              Is it Lucio Phenomenon or Necrotic Erythema Nodosum Leprosum?

              Lucio phenomenon (LP) or erythema necroticans is a relatively rare, peculiar reaction pattern occurring in untreated lepromatous (LL) or borderline lepromatous (BL) leprosy cases. A 38-year-old male, a cook by occupation, was referred to the dermatology clinic from otolaryngology department with blistering over both the hands and feet of 2 days duration. He had been admitted 1 week back with epistaxis and nasopharyngeal myiasis in otolaryngology department. He was started on systemic antibiotics gentamycin, crystalline penicillin, and metronidazole with nasal instillation of turpentine oil 2 drops 6 times a day. Two days later, he had developed edema with painless hemorrhagic blistering over the dorsum of left hand followed by involvement of the right hand, dorsa of both feet, and both the earlobes within a day. Histopathology of the blister showed sub-epidermal blister, with necrotizing leukocytoclastic vasculitis of papillary dermal vessels with thrombosis, numerous acid-fast bacilli in macrophages, and macrophage granulomas extending up to subcutis. In view of the absent fever or constitutional symptoms, and the classical angular infarcts and hemorrhagic blisters evolving into ulcers with angulated margins, we considered LP as the most likely diagnosis. The patient was started on a combination of WHO recommended multibacillary anti-leprosy therapy and prednisolone (40 mg/day).
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                Author and article information

                Journal
                anales
                Anales de la Facultad de Ciencias Médicas (Asunción)
                An. Fac. Cienc. Méd. (Asunción)
                EFACIM. Editorial de la Facultad de Ciencias Médicas - Universidad Nacional de Asunción (Asunción, Central, Paraguay )
                1816-8949
                August 2022
                : 55
                : 2
                : 88-91
                Affiliations
                [1] San Lorenzo Asunción orgnameUniversidad Nacional de Asunción orgdiv1Facultad de Ciencias Médicas orgdiv2Hospital de Clínicas, Cátedra de Dermatología Paraguay
                Article
                S1816-89492022000200088 S1816-8949(22)05500200088
                10.18004/anales/2021.055.02.88
                8843be99-1c3c-42be-9147-8e9952a670fe

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 13 April 2022
                : 01 July 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 4
                Product

                SciELO Paraguay

                Categories
                Reporte de Casos

                Vasculitis leukocytoclastic cutaneous.,Lepra,lepra lepromatosa,vasculitis leucocitoclástica cutánea.,Leprosy,Lepromatous leprosy

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