(CS2) Lucio's Phenomenon, Complication of Neglected Leprosy: A Case Series from Malaysia

Introduction: Lucio’s phenomenon (LP), characterized by severe necrotizing cutaneous vasculitis, is a rare manifestation of lepromatous leprosy, due to high Mycobacterium leprae load. We describe 5 cases of LP who were admitted to the Dermatology Ward Hospital Kuala Lumpur between 2015 and 2021. Case series : Three Indonesians (2 males, 1 female) and two pregnant Malaysian females, with a mean age of 39.2 years presented with LP as the manifestation of leprosy. They had hypoesthetic skin patches for a mean of 16 months. All had grade 2 deformity, madarosis, thickened peripheral nerves, swelling and paresthesia of extremities, with extensive painful reticulated purpura and ulcerations of lower limbs. The mean bacteriological index and morphological index on slit skin smear were 3.9 and 1.2 respectively. Histopathology examinations of skin tissue revealed aggregates of foamy histiocytes in dermis and subcutaneous fat, thrombotic vasculopathy and presence of numerous bacilli on wade fite stain. They were prescribed daily rifampicin, clofazimine and dapsone for 3-4 weeks, followed by maintenance WHO Multibacillary regime together with prednisolone. The mean duration of in-patient stay was 33.6 days. The two pregnancies were complicated with anemia, oligohydramnios, and intrauterine growth restriction which led to preterm emergency caesarean section. Two patients developed dapsone induced anemia. Two suffered erythema nodosum leprosum concurrently. Three patients recovered with no relapse on surveillance, one loss to follow up, and one succumbed to sepsis. Conclusion : Management of LP is challenging. Intensive multi-drug therapy renders earlier elimination of live bacilli. In-patient supportive care and meticulous wound management are vital