Diffuse Lepromatous Leprosy with Lucio Phenomenon Caused by Mycobacterium leprae

Mycobacterium lepromatosis is the primary cause of diffuse lepromatous leprosy and has previously been linked to the Lucio phenomenon in Mexico. In this study, we demonstrate that M. leprae and M. lepromatosis are responsible for many of the leprosy infections in which the Lucio phenomenon occurs. A 47-year-old female presented with chief complaints of erythematous and purpuric lesions on her left lower extremity and bilateral upper extremities. Over the past month, she had experienced recurrent tingling sensations in both legs. The patient had widespread infiltration, no nodules, madarosis (eyelash loss), and thickening in both ears. An acid-fast bacilli analysis revealed a bacterial index of 4+ and a microscopy index of 7%. Biopsy tissue was lacking the epidermal layer, and there was a dermal layer of dilated blood vessels, an area of bleeding, and infiltration of neutrophil inflammatory cells, perivascular plasma cells, foam cells, histiocytes, lymphocytes, the endothelium, and perivascular regions by acid-fast bacilli. A polymerase chain reaction identified the presence of both M. leprae and M. lepromatosis. The patient's symptoms worsened rapidly and she developed ulcers on both hands and both legs, extending to the soles of the feet. She was admitted to the hospital 3 days after presentation. Based on the clinical symptoms, examination of tissue samples, and the polymerase chain reaction identification of coinfection with M. leprae and M. lepromatosis, a diagnosis of diffuse lepromatous leprosy was made. The M. leprae bacteria were verified by DNA sequencing.