- 期刊
Lucio's Phenomenon: A Fatal and Rare Cutaneous Presentation of Lepromatous Leprosy - A Case Report
Lucio氏現象：瘤型痲瘋的一種致命且罕見的皮膚表徵──個案報告
摘要
Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast bacillus. It is viewed as a nonfatal infectious disease that mainly affects the skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes. Lucio's phenomenon is an extremely uncommon reaction characterized by severe necrotizing skin lesions in patients with lepromatous leprosy. However, no case of such an unusual reaction has been reported in Taiwan. In our report, we present a case of leprosy complicated by Lucio's phenomenon in all four extremities with series of images and pathology. Aim and Objectives: Leprosy is a localized and nonfatal disease. This may lead to delayed diagnosis in non-endemic regions, such as Taiwan. We believe that this report will be helpful for clinicians to recognize this disease. Materials and Methods: A 32-year-old Indonesian woman was admitted to the emergency department with ulcerative lesions with well-demarcated margins in the geographic patterns of the four extremities. During hospitalization, wound culture yielded acid-fast bacilli (Moderate, 3+), and pathological reports demonstrated numerous leprosy bacilli. Therefore, the patient was diagnosed with leprosy. Lucio's phenomenon was also observed based on her clinical manifestations and pathological findings. Results: In addition to anti-leprosy multidrug therapy and empirical antibiotics, we performed a series of surgical debridements and reconstruction with cadaveric skin coverage and split-thickness skin grafting due to ischemic epidermal necrosis, which is a characteristic of Lucio's phenomenon. Conclusion: Leprosy is a rare infectious disease in Taiwan. Despite its low incidence in non-endemic countries, clinicians should be aware of the rare presentations of leprosy. In addition to anti-leprosy multidrug therapy, adequate wound care with surgical debridement and reconstruction with skin grafting is essential to prevent secondary bacterial infection if patients present with Lucio's phenomenon.
並列摘要
背景：痲瘋病為一種痲瘋分枝桿菌（抗酸性菌）造成的慢性感染症。通常被視為非致命性的傳染疾病，主要影響皮膚、周邊神經、上呼吸道粘膜及眼睛等。Lucio氏現象是一種極為罕見的反應，會在瘤型痲瘋病人身上造成嚴重皮膚壞死病灶。然而，並沒有相關案例在台灣被報告過。在我們的案例中，透過影像及病理照片呈現了一名痲瘋病患併發Lucio氏現象造成的四肢壞死性皮膚病灶。⽬的及⽬標：痲瘋通常被視為局部且非致命的傳染病，但在非流行病區如台灣，可能會造成延遲診斷。透過此案例相信對台灣的臨床醫師能在辨認此疾病上有所幫助。材料及⽅法：我們報告了一名32歲印尼籍女性，以四肢界線清楚的潰瘍病灶來急診。後續住院期間，傷口細菌培養出抗酸性桿菌，且病理切片結果呈現了許多痲瘋桿菌。且透過病患之臨床表現及病理發現，與Lucio氏現象相吻合。結果：除了抗痲瘋藥物使用與開立經驗性抗生素，我們施行了許多次的手術清創。因Lucio氏現象會造成皮膚的缺血性壞死，所以後續傷口重建方式採用大體皮膚覆蓋及分層皮膚移植。結論：痲瘋病在台灣是一種罕見的傳染病。即便在非流行病區痲瘋有較低的發生率，我們臨床醫師應該注意到特殊性皮膚病灶，診斷並且適當以藥物治療，以免進展成嚴重的Lucio氏現象。除了及時給予抗痲瘋藥物及經驗性抗生素，在Lucio氏現象病人上，進行手術清創且適當使用大體皮膚及後續皮膚移植是不可或缺的。