To the Editor.—
The article by Pursley et al1 about Lucio's phenomenon prompts us to report a similar case and to stress the benefits of plasma exchange in the management of severe type 2 reactional states in leprosy.
Report of a Case.—
A 76-year-old man who had just returned from Vietnam was referred to us because of poor general health and the recent appearance of erythematous skin nodules. Clinical examination revealed findings suggestive of lepromatous leprosy. A skin biopsy specimen showed a diffuse infiltration of the dermis, comprising many foamy histiocytes and few lymphocytes. Numerous acid-fast bacilli were present. The lepromin test result was negative.The patient was given 600 mg/day of rifampin and 25 mg/day of dapsone. Dapsone therapy was subsequently increased to 100 mg/day. Despite treatment, new crops of nodules appeared, spreading to involve the entire skin surface. Many of these lesions ulcerated (Figure). None of the
Wallach D, Cottenot F, Bussel A, Palangie A, Pennec J. Plasma Exchange Therapy in Lucio's Phenomenon. Arch Dermatol. 1980;116(10):1101. doi:10.1001/archderm.1980.01640340011005