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Sabtu, 02 Juli 2011

Necrotizing Vasculitis in Lucio Phenomenon -An Infrequent Case Reports-





Nyityasmono Tri Nugroho, Dedy Pratama
 
Necrotizing vasculitis leading to cutaneus infarctions is one of entity in Lucio’s phenomenon, an acute lepra reaction in non-nodular diffuse lepromatous leprosy patient. Lucio’s phenomenon is common in Mexico and Central America, but infrequent in other region, include South-East Asia. Prevalence in the second place in the world in number of cases, Brazil, has rates of 4.88 per 10,000 inhabitant. The vasculitis is described by a immune-complex deposition and ischemic necrosis of the epidermis and superficial dermis, heavy infestation of endothelial cells with acid-fast bacilli, and in the deeper dermis can be found endothelial proliferation and thrombosis of larger vessel. Some entities revealed a mimicking with the antiphospholipid thrombotic syndrome (APS), and difficult to distinguished. Lucio’s phenomenon are histologically diagnosed, and anti-leprosy, wound care, antibiotics treated. Here a case, male, 25 y.o, has a purple-bluish color of the tip of digits of bilateral feet and dorsal side of bilateral hand since seven days before admission. He is diagnosed lepra since ten years before admission. Laboratories shows he has APS with elevated anticardiolipin antibodies and beta-2 glycoprotein of immunoglobulin. Under Doppler scanning demarcated a vasculitis without deep vein thrombosis. Histologically revealed a Lucio’s phenomenon lepromatous leprosy type.

Discussion
A Lucio’s phenomenon is a rare cases, and concomittant with APS is a unique entity. Approach of holistic treatment is carefully given, optimal wound care, corticosteroid, leprosy drugs, and antibiotics make a better outcome.

Keywords: Lucio’s phenomenon, antiphospolipid thrombotic syndrome, lepromatous leprosy

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