02106nas a2200277   4500000000100000008004100001260001600042653000900058653001500067653001800082653001100100653002500111653000900136653001300145653001500158653003500173653002200208100001300230700001400243700001100257245004900268300000700317490000700324520148300331022001401814       2008                            d  c2008 Feb 2810aAged10aBacteremia10aFatal Outcome10aHumans10aLeprosy, lepromatous10aMale10aNecrosis10aSkin Ulcer10aStaphylococcal Skin Infections10aTreatment Refusal1 aKumari R1 aThappa DM1 aBasu D00aA fatal case of Lucio phenomenon from India.  a100 v143 a<p>A 65-year-old man presented with cutaneous ulcerations involving the legs, hands, abdomen, buttocks, and pinna, along with fever, arthralgia, and anorexia for the prior 10 days. On cutaneous examination, dark, irregular-shaped bizarre erythematous purpuric spots and angulated ulcers were seen over bilateral, upper extremities and trunk including dorsum of hands, finger tips and the pinnae of both ears. Most striking were the presence of multiple deep ulcers covered with a blackish eschar and in some areas yellow slough eroding the subcutaneous tissue with ragged margins. These ulcers were distributed symmetrically over the thighs, lower legs and gluteal region. Slit-skin smear examination revealed a bacterial index (BI) of 6+ with globi from earlobes, ulcers 3+, eyebrows 3+ and normal skin 2+ and morphologically showed mainly solid (20-30%), fragmented (60-70%) and granular (5-10%) acid-fast bacilli. Biopsy from the ulcer margin revealed an ulcerated epidermis and dermis. The dermis had infiltrate of foamy macrophages, and evidence of ischemic necrotizing vasculitis, with fibrinoid necrosis and new vessel formation. There was presence of clumps of acid-fast bacilli (AFB) within macrophages, periadnexally, perivascularly, and also within endothelial cells. These clinical and histopathological features helped us to arrive at the diagnosis of Lucio phenomenon in an untreated case of Lucio leprosy which is rarely reported from areas other than Mexico.</p>  a1087-2108