Syphilis, leprosy, and human immunodeficiency virus coinfection: a challenging diagnosis.

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.

Coorte multicêntrica de pacientes com hanseníase tratada com terapiade dose única: resultados de três anos de seguimento e perspectiva emsáude pública no Brasil / SINGLE LESION LEPROSY PACIENTS MULTICENTRIC COHORT TREATED WITH SINGLE DOSE DRUG THERAPY: FINDINGS ON THREE-YEAR FOLLOW-UP AND PUBLIC HEALTH PERSPECTIVE IN BRAZIL

Single skin lesion, paucibacillary (SSL-PB) leprosy is considered an early diseasemanifestation. This study evaluated the clinical outcome of a cohort of 259 newlydiagnosed SSL-PB treated with one dose of rifampicin, ofloxacin, minocycline (ROM)and followed-up for three-years. Patients were recruited from the North, Central Westand Southeast regions in Brazil (1997-2001). The result expected with ROM therapywas disappearance or the reduction of lesion size. Manifestations that required additional intervention were considered as poor clinical outcome: type-1 reaction (T1R) with orwithout neuritis, neuritis alone, increase in lesion size and shift from paucibacillary tomultibacillary. The incidence of poor clinical outcome was calculated by personmonthand with the Kaplan-Meier methods. 61.8% of the participants were females,mean age 32.2, and 67.2% had borderline tuberculoid (BT) or tuberculoid forms. T1Rwas the predominant event; shift from paucibacillary to multibacillary was rare. 92.0%of the volunteers shown no events during the first year, the same occurring to 80.6%of them after 3 years of clinical monitoring. The probability of remaining event-freewas highest among those 40 years old or younger. Poor outcome predominated amongBT patients. Extended monitoring of SSL-PB leprosy cases under minimal therapyprovided valuable case management information for reference centers.

Lesão única paucibacilar (SSL-PB) é considerada manifestação clínica inicial dahanseníase. Este estudo avaliou resultado clínico de coorte de 259 pacientes SSL-PBrecém-diagnosticados, tratados com esquema de dose única Rifampicina, Ofloxacina,Minociclina (ROM) e acompanhados por 3 anos (1997-2001) nas regiões Norte,Centro-Oeste e Sudeste. O resultado esperado do tratamento ROM compreendedesaparecimento ou diminuição da lesão. O desfecho foi definido como qualquerevento clínico com indicação de terapia adicional: reação tipo 1 (T1R) com ou semneurite, neurite, aumento de tamanho de lesão e mudança de paucibacilar paramultibacilar. Estas manifestações foram consideradas eventos clínicos desfavoráveis,calculados por densidade de incidência (pessoa-tempo) e por Kaplan-Meier. 61,8%dos participantes eram mulheres (32,2 média idade), 67,2% borderline-tuberculoide(BT) e tuberculoide. T1R foi o desfecho predominante; mudança de paucibacilar paramultibacilar foi rara. 92,0% não apresentaram eventos desfavoráveis no primeiro anoe 80,6% ao final de três anos de monitoramento clínico. Participantes com idade d?40 anos tiveram maior probabilidade de permanecerem sem evento e evolução clínicadesfavorável predominou entre pacientes BT. Monitoramento prolongado de hanseníaselesão-única PB tratados com esquema mínimo forneceu dados importantes sobremanejo clínico para os centros de referência.