Leprosy, Syphilis, and Human Immunodeficiency Virus Coinfection: A Case Report

Coinfection between leprosy, syphilis and HIV is very rare, and this association remains unclear. We report 55 years old man from Bantul, Indonesia, who present almost all over the body covered with erytematous patches and plaques in various sizes, multiple, discrete with ulnaris nerve enlargement. This patient was diagnosed as BL leprosy, secondary syphilis and HIV infection. Laboratory investigation showed Bacterial Index 3+ and Morphological Index 43.75%, positive TPHA, VDRL 1/32, and HIV reactive with CD4 count 4. Histologic finding demonstrated as acute viral exanthem. We treated this patient with WHO-multidrug therapy regimen for MB leprosy, benzathin penicillin 2.4 million unit IM single dose, and triple FDC (tenofovir, hiviral, and efavirenz) once a day. A month after therapy, VDRL was surprisingly increasing to 1/256 in titer. Hence, we re-treated him with benzatin penicillin 2,4 million unit once a week for 3 consecutive weeks. We conclude that coinfection between these three diseases make the clinical manifestation and histological become atypical, and it amay influence each other. Treatment of these diseases combination was the same as the disease separately.