Introduction: which have ulcerated. Skin split smear from 6

Introduction: Leprosy andtuberculosis (TB) although not uncommon in developing countries, theconcomitant occurrence of both diseases in the same patient is rare.

We report a case of 47-year-old man whopresented with pulmonary tuberculosis and lepromatous leprosy coinfection. Case: A47- year-old Indonesian man presented with multiple nodules and plaques on histrunk and limbs for the past one month. Furthermore he gave respiratorysymptoms of productive cough and fever for the past 10 days which wasassociated with a loss of appetite. On examination, there were multiple tenderand firm 2 x 2 centimeters nodules on his face, trunk and limbs, some of whichhave ulcerated. Skin split smear from 6 sites revealed bacterial index of 4.5with morphological index of 3.1.

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Mantoux test on the forearm was positive (14millimetres induration at 48 hours) and sputum for acid fast bacilli waspositive (1+). Chest radiograph was normal. Biopsyfrom a nodule on the forearm showed foamy macrophages infiltrationwith numerous acid fast bacilli are present within. Adiagnosis of lepromatous leprosy complicated with type 2 reaction and sputumpositive pulmonary tuberculosis was made. He was started on multidrug therapy(MDT), anti TB treatment and systemic corticosteroids for type II lepraereaction.

. He developed complications of anti-TB induced transaminitis anddapsone induced hemolysis. Treatment was substituted with second line anti-TBregime and he was discharged well 27 days later. Discussion: This case highlights the need to recognise concomitant infectionwith tuberculosis and leprosy to avoid leprosy treatment becoming a TB “monotherapy” .

The exact interactionbetween these mycobacterium infections remains unanswered, molecular studiesindicate that a defect in Toll-like receptor 2 (TLR-2) may blunt the triggeringof host defense mechanism. Conclusion: Thecoinfection of leprosy and pulmonary tuberculosis is uncommon and a high indexof suspicious is necessary for diagnosis.