Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient
Background: Vasculonecrotic reactions in leprosy are typically associated with type 2 reactions. Differentiating between necrotizing erythema nodosum leprosum (nENL) and Lucio’s phenomenon (LP) can be difficult, as overlapping clinical and histopathological features have been reported. <i>Myco...
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2025-05-01
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| author | Fernando Amador-Lara Jorge L. Mayorga-Garibaldi Felipe J. Bustos-Rodríguez Luz A. González-Hernández Pedro Martínez-Ayala Jaime F. Andrade-Villanueva |
| author_facet | Fernando Amador-Lara Jorge L. Mayorga-Garibaldi Felipe J. Bustos-Rodríguez Luz A. González-Hernández Pedro Martínez-Ayala Jaime F. Andrade-Villanueva |
| author_sort | Fernando Amador-Lara |
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| description | Background: Vasculonecrotic reactions in leprosy are typically associated with type 2 reactions. Differentiating between necrotizing erythema nodosum leprosum (nENL) and Lucio’s phenomenon (LP) can be difficult, as overlapping clinical and histopathological features have been reported. <i>Mycobacterium lepromatosis</i>, a recently identified species causing leprosy, has been sporadically linked to LP. While type 1 reactions are more commonly observed in HIV-coinfected individuals, reports of LP or ENL occurring outside the context of immune reconstitution inflammatory syndrome (IRIS) remain rare. Methods: We report a case of a vasculonecrotic leprosy reaction due to <i>M. lepromatosis</i> in an antiretroviral-naive patient with advanced HIV infection. Results: The patient presented with a two-month history of papules and nodules that progressed to painful necrotic ulcers, accompanied by systemic symptoms. Clinically, the presentation was consistent with nENL; however, histopathological analysis supported a diagnosis of LP. The patient rapidly deteriorated, developing septic shock and dying shortly thereafter. To our knowledge, this is the first reported case of a leprosy-associated vasculonecrotic reaction caused by <i>M. lepromatosis</i> in an HIV-infected individual not associated with IRIS. Conclusions: Vasculonecrotic reactions in leprosy are life-threatening emergencies due to their potential for rapid clinical deterioration and sepsis. In individuals with advanced HIV infection, recognition of these reactions may be challenging, as they can mimic other opportunistic infections, including fungal diseases, malignant syphilis, and disseminated mycobacterial infections. Early identification and prompt treatment are critical to improving outcomes. |
| format | Article |
| id | doaj-art-e5629215f2d2413c8d43b95d97e92d04 |
| institution | Kabale University |
| issn | 2036-7449 |
| language | English |
| publishDate | 2025-05-01 |
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| series | Infectious Disease Reports |
| spelling | doaj-art-e5629215f2d2413c8d43b95d97e92d042025-08-20T03:24:39ZengMDPI AGInfectious Disease Reports2036-74492025-05-011735810.3390/idr17030058Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected PatientFernando Amador-Lara0Jorge L. Mayorga-Garibaldi1Felipe J. Bustos-Rodríguez2Luz A. González-Hernández3Pedro Martínez-Ayala4Jaime F. Andrade-Villanueva5Departamento de Clínicas Medicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, MexicoUnidad de Diagnóstico en Microbiología Médica y Enfermedades Infecciosas, Guadalajara 44340, MexicoDepartamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, MexicoDepartamento de Clínicas Medicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, MexicoDepartamento de Clínicas Medicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, MexicoDepartamento de Clínicas Medicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, MexicoBackground: Vasculonecrotic reactions in leprosy are typically associated with type 2 reactions. Differentiating between necrotizing erythema nodosum leprosum (nENL) and Lucio’s phenomenon (LP) can be difficult, as overlapping clinical and histopathological features have been reported. <i>Mycobacterium lepromatosis</i>, a recently identified species causing leprosy, has been sporadically linked to LP. While type 1 reactions are more commonly observed in HIV-coinfected individuals, reports of LP or ENL occurring outside the context of immune reconstitution inflammatory syndrome (IRIS) remain rare. Methods: We report a case of a vasculonecrotic leprosy reaction due to <i>M. lepromatosis</i> in an antiretroviral-naive patient with advanced HIV infection. Results: The patient presented with a two-month history of papules and nodules that progressed to painful necrotic ulcers, accompanied by systemic symptoms. Clinically, the presentation was consistent with nENL; however, histopathological analysis supported a diagnosis of LP. The patient rapidly deteriorated, developing septic shock and dying shortly thereafter. To our knowledge, this is the first reported case of a leprosy-associated vasculonecrotic reaction caused by <i>M. lepromatosis</i> in an HIV-infected individual not associated with IRIS. Conclusions: Vasculonecrotic reactions in leprosy are life-threatening emergencies due to their potential for rapid clinical deterioration and sepsis. In individuals with advanced HIV infection, recognition of these reactions may be challenging, as they can mimic other opportunistic infections, including fungal diseases, malignant syphilis, and disseminated mycobacterial infections. Early identification and prompt treatment are critical to improving outcomes.https://www.mdpi.com/2036-7449/17/3/58vasculonecrotic reactionleprosyHIV infection<i>Mycobacterium lepromatosis</i>necrotizing erythema nodosum leprosumLucio’s phenomenon |
| spellingShingle | Fernando Amador-Lara Jorge L. Mayorga-Garibaldi Felipe J. Bustos-Rodríguez Luz A. González-Hernández Pedro Martínez-Ayala Jaime F. Andrade-Villanueva Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient Infectious Disease Reports vasculonecrotic reaction leprosy HIV infection <i>Mycobacterium lepromatosis</i> necrotizing erythema nodosum leprosum Lucio’s phenomenon |
| title | Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient |
| title_full | Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient |
| title_fullStr | Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient |
| title_full_unstemmed | Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient |
| title_short | Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient |
| title_sort | vasculonecrotic reaction caused by mycobacterium lepromatosis infection a case report of an hiv leprosy coinfected patient |
| topic | vasculonecrotic reaction leprosy HIV infection <i>Mycobacterium lepromatosis</i> necrotizing erythema nodosum leprosum Lucio’s phenomenon |
| url | https://www.mdpi.com/2036-7449/17/3/58 |
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