Lucio’s phenomenon in untreated advanced leprosy

A 77-year-old woman with underlying diabetes mellitus, hypertension and Parkinson disease presented to the emergency department with burn injury after dipping her foot into hot water. She was admitted with 75% dermal thickness burn of bilateral foot. On examination, she was noted to have extensive purpuric patches with livedo reticularis. Further examination revealed leonine facies, madarosis and hypoaesthesia of the lower limbs. Slit skin smear exhibit bacillary index of 3.5 (moderate acid-fast bacteria present). Skin biopsy showed perivascular lymphocytic and foamy histiocytic inflammation with vascular thrombosis (Fig. 1; H&E, 100×) and presence of acid-fast bacilli (Fig. 2; Ziehl-Neelsen stain, 400×), features that are consistent with lepromatous leprosy with Lucio’s phenomenon. This patient was started on antileprosy multidrug therapy (clofazimine, rifampicin and dapsone). However, she developed multiple ulcers, pressure sores and had recurrent infections while in ward stay that required multiple antibiotics regime and daily dressing. She succumbed 3 months following admission due to septic shock secondary to infected ulcers.