02351nas a2200361   4500000000100000008004100001260001300042653001000055653002600065653001100091653001600102653002200118653001900140653001100159653002800170653000900198653002800207653001300235653002200248653002300270100001300293700002500306700001300331700001500344700001600359700001300375700001200388245009400400300000900494490000700503520146500510022001401975       2013                            d  c2013 Aug10aAdult10aAnti-Bacterial Agents10aBrazil10aCoinfection10aFollow-Up Studies10aHIV Infections10aHumans10aLeprosy, Paucibacillary10aMale10aPenicillin G Benzathine10aSyphilis10aTreatment Outcome10aTreponema pallidum1 aSouza CF1 aBornhausen-Demarch E1 aPrata AG1 aAndrade FC1 aFernandes M1 aLopes MR1 aNery JA00aSyphilis, leprosy, and human immunodeficiency virus coinfection: a challenging diagnosis.  a71-60 v923 a<p>The association between syphilis, leprosy, and human immunodeficiency virus (HIV) is not well documented, and the emergence of isolated cases raises the interest and indicates that this triple coinfection can occur. We report the case of a 42-year-old man from Rio de Janeiro, Brazil, who presented with erythematous papules on the trunk, back, and upper and lower extremities; an erythematous plaque on the upper abdomen; and an erythematous violaceous plaque on the right thigh with altered sensitivity. Laboratory investigation showed a reagent VDRL test (1:512) and positive test results for Treponema pallidum hemagglutination. Treatment with benzathine penicillin (2,400,000 U intramuscularly) was started (2 doses 1 week apart). On follow-up 40 days later, the lesions showed partial improvement with persistence of the plaques on the right thigh and upper abdomen as well as a new similar plaque on the back. Further laboratory examinations showed negative bacilloscopy, positive HIV test, and histologic findings consistent with tuberculoid leprosy. The patient was started on multidrug therapy for paucibacillary leprosy with clinical improvement; the patient also was monitored by the HIV/AIDS department. We emphasize the importance of clinical suspicion for a coinfection case despite the polymorphism of these diseases as well as the precise interpretation of laboratory and histopathology examinations to correctly manage atypical cases. </p>  a2326-6929