Leprosy in a Patient Coinfected with HIV and Syphilis

Case report of a male patient, fifty years old, born in the Amazon region of Belém, Pará, northern Brazil. He was attended at a University service of reference in Dermatology on 09/14/2018, referring to "ball injuries" about a year ago with a sudden and progressive appearance in the abdomen with dissemination to the whole body. Three months ago he was diagnosed as a person living with the HIV Virus (PLHIV) and Antiretroviral Therapy (ART) with TDF + 3TC + DTG was started and VDRL positive (1/256) already under treatment with Benzathine penicillin. Physical examination revealed the presence of erythematous-infiltrated nodules, some of which were confluent and normochromic and were disseminated in the auricle, face, trunk, upper limbs and in a smaller number in the lower limbs. The patient was confused in the thermal sensitivity test and complained of numbness. Under suspicion of leprosy, smear microscopy of skin with 5+ positive result and histopathological biopsy of the skin lesion.  Patient was also diagnosed with Secondary Syphilis and Leprosy clinical form Virchowiana, treatment with multibacillary specific multidrug-resistant chemotherapy (MDT-MB) allied to prednisone at the inicial dose 60mg. This case shows a coinfection, Human Immunodeficiency Virus (HIV), Leprosy and Syphilis, the relation of HIV-Leprosy and the influence of Syphilis on this coinfection, changing the clinical form and their evolutions.