Leprosy is a chronic disease caused by Mycobacterium leprae and remains a major public health issue in endemic regions such as Brazil. Lepromatous leprosy is the most contagious and severe form, characterized by hematogenous dissemination, leonine facies, and diffuse involvement of skin, peripheral nerves, and internal organs. In rare cases, it can progress to Lucio’s phenomenon, a rare reactional form seen in untreated patients, with generalized necrotizing vasculitis leading to skin necrosis, sepsis, and multiorgan failure. We report the case of a 23-year-old male, former drug user, previously healthy, admitted for investigation of extensive ulcerated lesions that began about 4 years earlier as small lower-limb ulcers and progressed to widespread lesions on upper limbs, trunk, face, and mucosa, with loss of thermal and tactile sensation. He denied recent medication use but had a significant family history (mother treated for leprosy after pregnancy; the patient was not evaluated in childhood). Exam showed leonine facies, madarosis, generalized lymphadenopathy, hepatosplenomegaly, and multiple deep ulcers with slough, bleeding, and pus. Labs revealed severe anemia (Hb 6.7 g/dL), leukocytosis, CRP >270 mg/dL, acute kidney injury, cholestatic hepatitis, and coagulopathy. Lesion cultures grew multidrug-resistant Pseudomonas aeruginosa. Abdominal CT showed marked hepatosplenomegaly with splenic infarcts; chest CT showed pleural effusion and pulmonary congestion. Skin biopsy confirmed multibacillary leprosy (smear +++, bacillary index >4). Management included broad-spectrum antibiotics, multidrug therapy (rifampicin, dapsone, clofazimine), corticosteroids (prednisone 1 mg/kg/day), ventilatory support, and ICU care. Despite the severity of the condition, improvement in the cutaneous lesions was observed, although systemic complications persisted, including a pericardial friction rub and renal failure. After 17 days of hospitalization, the patient died due to multiple systemic complications. Despite therapeutic advances, Lucio’s phenomenon still carries a high mortality rate, even with appropriate antibiotic therapy and intensive supportive care. This case underscores the need for training healthcare teams in endemic areas for early recognition and prompt treatment.
Fernandes et al. (Sun,) studied this question.