Necrotic erythema nodosum reaction associated with histological alterations of Lucio’s phenomenon

Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio’s phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.

Keywords:
Leprosy; Multibacillary leprosy; Mycobacterium infections; Mycobacterium leprae

Authorship

Larissa Daniele Machado Góes ^**Corresponding author. E-mail:larissadaniele55@gmail.com (L.D. Góes).

Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, BrazilFundação de Dermatologia Tropical e Venereologia Alfredo da MattaBrazilManaus, AM, BrazilFundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil

https://orcid.org/0000-0003-4140-3247

Patrícia Motta de Morais

Department of Dermatopathology, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, BrazilDepartment of DermatopathologyBrazilManaus, AM, BrazilDepartment of Dermatopathology, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil

https://orcid.org/0000-0003-4216-1657

Paula Frassinetti Bessa Rebello

Department of Tropical Diseases, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, BrazilDepartment of Tropical DiseasesBrazilManaus, AM, BrazilDepartment of Tropical Diseases, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil

https://orcid.org/0000-0002-9503-7185

Antônio Pedro Mendes Schettini

https://orcid.org/0000-0002-5357-9189

*Corresponding author. E-mail:larissadaniele55@gmail.com (L.D. Góes).

☆
Study conducted at the Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil.

Authors' contributions

Larissa Daniele Machado Góes: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.

Patrícia Motta de Morais: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.

Paula Frassinetti Bessa Rebello: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.

Antônio Pedro Mendes Schettini: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.

Conflicts of interest

None declared.

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Figures

Figures (3)

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Figure 1
Presence of papules, pustules and crusts on the upper limbs and trunk.

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Figure 2
(A), Erythematous papules, pustules and crusts affecting the left upper limb. (B), Bullae with purulent content on the left plantar region.

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Figure 3
(A), Necrosis of the epidermis and dense inflammatory infiltrate in the dermis are observed (Hematoxylin & eosin, ×10). (B), Neutrophilic infiltrate on the wall and around the vessels (Hematoxylin & eosin, ×40). (C), Vacuolated macrophages containing large amounts of intact and fragmented bacilli (Wade, ×40).

Figure 1 Presence of papules, pustules and crusts on the upper limbs and trunk.

Figure 2 (A), Erythematous papules, pustules and crusts affecting the left upper limb. (B), Bullae with purulent content on the left plantar region.

Figure 3 (A), Necrosis of the epidermis and dense inflammatory infiltrate in the dermis are observed (Hematoxylin & eosin, ×10). (B), Neutrophilic infiltrate on the wall and around the vessels (Hematoxylin & eosin, ×40). (C), Vacuolated macrophages containing large amounts of intact and fragmented bacilli (Wade, ×40).

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