Purpura fulminans like presentation of Lucio Leprosy: A case report

We report a 65-year-old man with untreated lepromatous leprosy who presented with rapidly progressive purpuric lesions, hemorrhagic bullae, and necrotic ulcers initially misdiagnosed as idiopathic purpura fulminans and admitted in the intensice care unit. Clinical features (e.g., madarosis, leonine facies, peripheral neuropathy), slit-skin smear positivity, histopathology showing foamy histiocytes and acid-fast bacilli in globi, and normal coagulation profile confirmed Lucio phenomenon. Prompt initiation of multidrug therapy led to lesion healing, thus showing importance of recognizing this rare vasculonecrotic reaction to avoid diagnostic delays in diffuse lepromatous leprosy.