Leprosy in the acquired immunodeficiency syndrome [letter]

The case of a 43-year-old homosexual man who had lived in Brazil from 1972-85 presents a unique combination of leprosy tuberculosis and acquired immunodeficiency syndrome (AIDS). The patient presented to a hospital in the Netherlands in 1985 with a large annular partially anesthetic lesion with raised borders and a healing center on the left forearm. Borderline tuberculoid leprosy was diagnosed. Although treatment with dapsone and clofazimine resulted in inactivation of the leprosy lesion the patients clinical profile worsened. He showed progressive malaise fatigue weight loss a productive cough diarrhea lymphadenopathy and a seborrheic eczema-like dermatitis. biopsy samples of the skin and oral mucosa revealed Kaposis sarcoma and a pathological examination of a hemorrhoid showed 2 foci of Kaposis sarcoma. In addition Mycobacterium tuberculosis was isolated in the patients sputum. Serum testing revealed the presence of antibodies to human immunodeficiency virus (HIV); the patients T4/T8 ratio was 0.6. Given the disturbances in cell-mediated immunity in patients with leprosy the coexistence in this case of leprosy and AIDS raises serious concerns and could lead to a detrimental impact on the epidemiology of leprosy in African countries.