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Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient

Year: 2025

Type: article

Abstract: Background: Vasculonecrotic reactions in leprosy are often present in the context of a type 2 leprosy reaction. Differentiation between necrotizing ery-thema nodosum leprosum (nENL) and Lucio's phenomenon (LP) can be dif-ficult, and cases of overlapping reactions have been reported. Mycobacterum lepromatosis, a relatively new species causing leprosy, has been sporadically reported to cause LP. Type 1 leprosy reaction occurs more commonly in HIV-coinfected individuals, and only sporadic cases of LP and ENL have been reported in the context of unmasked or paradoxical immune reconstitu-tion inflammatory syndrome (IRIS). Methods: We present a case of a vascu-lonecrotic reaction in an antiretroviral-naive leprosy/HIV-coinfected indi-vidual caused by M. lepromatosis. Results: The patient had a 2-month course of papules and nodules that evolved into painful necrotic ulcers accompanied by systemic symptoms. The lesions were consistent with nENL; however, the histopathological findings were more consistent with LP. The patient rapidly progressed to sepsis and died. Conclusions: Vasculonecrotic reactions are considered a life-threatening medical emergency, and sepsis is a common complication. To our knowledge, this is the first reported case of a leprous vasculonecrotic reaction in an HIV-infected individual not associated with IRIS caused by M. lepromatosis. Leprosy vasculonecrotic reactions may not be easily recognized in HIV-infected individuals, particularly those with severe immunosuppression, where opportunistic infections, especially fungal infec-tions, malignant syphilis, and other mycobacteriosis, may present similar findings. Delayed diagnosis can lead to severe complications and risk of death.

Source: Infectious Disease Reports

DOI: 10.3390/idr17030058

Authors: Fernando Amador-Lara, Jorge Leonardo Mayorga-Garibaldi, Felipe Jesus Bustos-Rodríguez, Luz Alicia González-Hernández, Pedro Martínez-Ayala, Jaime Federico Andrade-Villanueva

Institutions: Universidad de Guadalajara, Hospital Civil de Guadalajara

Language: English

Topic: Leprosy Research and Treatment

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,172