An 18 years old female presented with one year history of progressing intermittent shortness of breath, joint pain and swelling, photosensitivity, fatigue, and non- scarring alopecia started with the frontal hairline, eyebrows, and eyelash

    Clinical History:

    Two years ago, an 18 years old female presented in our hospital with one year history of intermittent shortness of breath, joint pain and swelling, photosensitivity, fatigue, and alopecia. The nonscarring alopecia started with the frontal hairline, eyebrows, and eyelashes then progressed to the forearms and back. Therefore, she was diagnosed as a SLE and referred to Rheumatologist for further treatment and work-up. The clinical work-up revealed that increased

    ANA (1:320), anti-Cardiolipin ab (aCL, 355), anti-β2-glycoprotein 1 ab (392), and p-ANCA (1:160). Leprosy was not diagnosed in her previous visit. Her symptoms progressed and recently she visited our Dermatologist again for further treatment and follow-up tests under clinical impressions of alopecia areata, lupus/SLE, or vasculitis or leprosy. On neurological examination, there was sensory loss. She stated that her uncle in Cuba was diagnosed as leprosy.

     

    Microscopic description of the left eyebrow and right leg biopsies:

    Histologically, the eyebrow biopsy showed pandermic perineural, perivascular, and periadenxal foamy macrophage infiltrates, which contained numerous FITE-positive single or globi of acid-fast bacilli. No panniculitis or thrombus was identified. The leg biopsy showed pandermic and pansubcutaneous thrombosed vessels and striking pansubcutaneopus necrotizing panniculitis with numerous FITE-positive bacilli-containing foamy macrophage infiltrates. A focal epidermal necrosis above the thrombosed vessels was observed. The rest of dermis showed perivascular and periadnexal foamy macrophages also containing numerous FITE-positive acid-fast bacilli. No apparent leukocytoclastic vasculitis or active vasculitis were identified. In terms of the presence of Lucio’s phenomenon such as pandermic and pansubcutaneous thrombosed vessels, panniculitis, and numerous FITE-positive bacilli-laden macrophages, a diagnosis of diffuse lepromatous leprosy (DLL, Lucia-Latapi leprosy) with Lucio's phenomenon was made. The increased anti-cardiolipin antibody and ANA also support Lucio’s phenomenon. PCR test is currently pending.