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Pierre Couppié, MD; Sylvie Abel, MD; Hélène Voinchet, MD; Morgane Roussel, MD; Raymond Hélénon, MD; Michel Huerre, MD; Dominique Sainte-Marie, MD; André Cabié, MD

Arch Dermatol. 2004;140:997-1000.

Background  Immune reconstitution inflammatory syndrome (IRIS) is an unusual inflammatory reaction to an opportunistic infection that occurs in human immunodeficiency virus (HIV)–positive patients with profound immunosuppression during the reconstitution of the immune system in the initial months of highly active antiretroviral treatment.

Observations  We describe 3 cases of leprosy occurring in patients treated with a combination of 3 antiretroviral drugs who fulfilled the criteria for IRIS. A reactional state occurred in all 3 cases. Two of the 3 patients presented an unusual ulcerous progression of the lesions not generally observed in cases of leprosy. The outcome was favorable in all 3 cases. The frequency of IRIS associated with leprosy in French Guiana and Martinique is estimated at 3 cases per 1000 HIV-positive patients receiving highly active antiretroviral treatment.

Conclusion  Leprosy should be recognized as an IRIS-associated infection with possibility of atypical presentation.

From the Institut Guyanais de Dermatologie Tropicale (Drs Couppié and Sainte-Marie), the Service de Dermatologie (Drs Couppié, Voinchet, Roussel, and Sainte-Marie), and the Centre d'Information et de Soins de l'Immunodéficience Humaine de Guyane (Dr Couppié), Centre Hospitalier de Cayenne, French Guiana; the Centre d'Information et de Soins de l'Immunodéficience Humaine de la Martinique, Centre Hospitalier Universitaire de Fort-de-France (Drs Abel, Hélénon, and Cabié); and the Unité d'Histopathologie, Institut Pasteur, Paris, France (Dr Huerre). The authors have no relevant financial interest in this article.

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