Lucio Phenomenon Mimicking Necrotizing Myofasciitis: A Case Report Study
Main Article Content
Lucio phenomenon is a rare but severe lepra reaction occurring in untreated patients with diffuse lepromatous leprosy, characterized by widespread cutaneous necrosis due to endothelial invasion and vascular thrombosis caused by Mycobacterium leprae. Its clinical resemblance to necrotizing soft tissue infections often leads to diagnostic confusion and inappropriate surgical intervention. We report a case of a 47-year-old man presenting with bilateral necrotic ulcers of the lower limbs, initially diagnosed as necrotizing myofasciitis and scheduled for debridement. However, further dermatological evaluation revealed hallmark signs of multibacillary leprosy, including madarosis, multiple anesthetic plaques, and sensory loss, in the absence of peripheral nerve thickening. A diagnosis of Lucio phenomenon was established, and surgical intervention was withheld in favor of initiating multidrug therapy (MDT) and supportive care. This case underscores the critical importance of early dermatological consultation and high clinical suspicion for atypical leprosy reactions in endemic regions, particularly in patients with rapidly progressive ulcers mimicking necrotizing infections.
Chen, K. H., Lin, C. Y., Su, S. B., & Chen, K. T. (2022). Leprosy: A review of epidemiology, clinical diagnosis, and management. Journal of Tropical Medicine, 2022, Article 8652062. https://doi.org/10.1155/2022/8652062
Frieda, Kariosentono, H., & Ellistasari, E. Y. (2022). Lucio phenomenon: A rare type of leprosy reaction. Journal of Communicable Diseases, 54(3), 2022. https://doi.org/10.24321/0019.5138.202238
Holly, A. A., Duane, T. M., & Collom, M. (2023). Necrotizing soft tissue infection. In Textbook of Emergency General Surgery: Traumatic and Non-traumatic Surgical Emergencies (pp. 1–12). Springer. https://doi.org/10.1007/978-3-031-22599-4_113
Hua, C., Urbina, T., Bosc, R., Parks, T., Sriskandan, S., de Prost, N., & Chosidow, O. (2023). Necrotising soft-tissue infections. The Lancet Infectious Diseases, 23(3), e95–e108. https://doi.org/10.1016/S1473-3099(22)00583-7
Kaur, M., Patra, S., Asati, D. P., Sharma, T., & Prasad, S. (2021). Lucio phenomenon in a patient of lepromatous leprosy from India. Indian Journal of Dermatology, Venereology and Leprology, 87(1), 114–116. https://doi.org/10.25259/IJDVL_114_20
Kementerian Kesehatan Republik Indonesia. (2024). Profil kesehatan Indonesia tahun 2023. Kemenkes RI. https://pusdatin.kemkes.go.id
Khadilkar, S. V., Patil, S. B., & Shetty, V. P. (2021). Neuropathies of leprosy. Journal of the Neurological Sciences, 420, Article 117288. https://doi.org/10.1016/j.jns.2020.117288
Makhakhe, L. (2021). Leprosy review. South African Family Practice, 63(1), a5311. https://doi.org/10.4102/SAFP.V63I1.5311
Mi, Z., Liu, H., & Zhang, F. (2020). Advances in the immunology and genetics of leprosy. Frontiers in Immunology, 11, 567. https://doi.org/10.3389/fimmu.2020.00567
Norman, T., Zikry, J., Worswick, S., Kim, G., & Ochoa, M. T. (2022). Lucio phenomenon with concomitant necrotizing fasciitis and acute kidney injury. Dermatology Online Journal, 28(3), 13030. https://doi.org/10.5070/D328357784
Ramam, M. (2019). The continuing relevance of leprosy. JAMA Dermatology, 155(10), 1081–1082. https://doi.org/10.1001/jamadermatol.2019.1730
Ramesh, V., & Girdhar, A. (2010). Lucio phenomenon in Indian patients: A report of three cases. Leprosy Review, 81(2), 164–170.
Rusia, K., Saoji, V., Madke, B., & Singh, A. (2024). Lucio phenomenon: An unusual case of skin necrosis. Case Reports in Dermatology, 16(1), 78–82. https://doi.org/10.1159/000536370
Sharma, R., Kaur, I., Dogra, S., Narang, T., & Kumar, B. (2008). Lucio phenomenon: An unusual presentation in leprosy. Indian Journal of Dermatology, Venereology and Leprology, 74(6), 640–642.
Stevens, D. L., Bryant, A. E., & Goldstein, E. J. (2021). Necrotizing soft tissue infections. Infectious Disease Clinics of North America, 35(1), 1–19. https://doi.org/10.1016/j.idc.2020.10.004
Urbina, T., Razazi, K., Ourghanlian, C., Woerther, P. L., Chosidow, O., Lepeule, R., & de Prost, N. (2021). Antibiotics in necrotizing soft tissue infections. Antibiotics, 10(9), 1104. https://doi.org/10.3390/antibiotics10091104
Vera-Cabrera, L., Hernández-Vidal, G., Welsh, O., & Salinas-Carmona, M. C. (2012). Lucio’s phenomenon: A case report and review of the literature. International Journal of Dermatology, 51(8), 943–949. https://doi.org/10.1111/j.1365-4632.2011.05399.x
World Health Organization. (2018). Guidelines for the diagnosis, treatment and prevention of leprosy. WHO Regional Office for South-East Asia.
