RESUMO
Introduction: Lucio phenomenon is a rare type of reaction in untreated, diffusely infiltrative form of lepromatous leprosy type, characterised with ulcerative type of skin lesions. Case: A 29 year old Indonesian female, 7th months primigravida with a four-month history of painful scarlet spots that darken and ulcerate on both of her hands and legs. The patient was experiencing fever. The patient's eyebrows were lost and her earlobes were thickened 3 years ago. Slit-skin smear: BI 6þ,MI 7%. Histopathology: Lucio phenomenon. PCR detecting M. leprae DNA on skin lesion and amniotic fluid: positive; umbilical cord membrane and umbilical cord: negative. Anti-PGL-1 IgM and IgG: patient: 4,854 U/mL and 1,061 U/mL, respectively; 5 month-old baby: 5 U/mL and 1,724 U/mL, respectively; 1 year-old baby: 0 U/mL and 3 U/mL, respectively. Conclusion: Placenta is considered a protective barrier toward feto-maternal transmission of M. leprae. The baby had the passive antibody to M. leprae from the mother's blood transmitted through the umbilical cord as demonstrated by the presence of anti-PGL-1 IgG antibody.
Assuntos
Hanseníase Virchowiana/diagnóstico , Mycobacterium leprae/isolamento & purificação , Complicações na Gravidez/diagnóstico , Adulto , Anticorpos Antibacterianos/sangue , Feminino , Humanos , Hansenostáticos/administração & dosagem , Hanseníase , Hanseníase Virchowiana/sangue , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/microbiologia , Mycobacterium leprae/genética , Mycobacterium leprae/crescimento & desenvolvimento , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/microbiologiaRESUMO
A 30 year old woman who presented with multiple numb patches on the body was initially diagnosed as borderline lepromatous leprosy and started on multidrug therapy for leprosy. She had an episode of Type 1 reaction during the fifth month of pregnancy. After delivery, she stopped therapy fearing harm to her child and developed an episode of Type 2 reaction. The reaction was unusual in that bullous lesions developed over previous leprosy patches which had initially become indurated, with associated neuritis. Histopathology revealed bullae with intense neutrophilic reaction and strong positivity for acid fast bacilli. There was no response to steroid therapy which was started for the reaction. Thalidomide had to be prescribed after stopping lactation by medical means. She responded dramatically to Thalidomide with regression of cutaneous lesions and neuritis. This patient is being reported as a very unusual manifestation of bullous erythema nodosum leprosum in the postpartum period responding dramatically to thalidomide.