Iris in an HIV seropositive leprosy patient

We read with interest the case report on the above subject. The authors have described a case of BL type of leprosy with type II reaction, who also had AIDS at the time of first presentation. The patient had the disease for over 2 years and ENL for 6 months. The course of the disease after the initiation of anti-leprosy treatment (ALT) was as expected in most cases. The ALT comprised rifampicin 600mg monthly, ofloxacin 400mg daily, minocycline 100mg daily and clofazimine 100mg thrice daily for 4 weeks, after which minocycline and ofloxacin were withdrawn. After 3 months of ALT, HAART was instituted along with the ALT. On giving ALT, the immunological status improves and is known to produce type I reaction in many cases, which is what happened with this patient. In this case, all the described symptoms appeared 1 month after HAART, which could be coincidental. Those of us who see and follow up a huge number of leprosy cases know that this is not an uncommon phenomenon in uncomplicated BL type of leprosy patients. Four criteria have been given by the authors to diagnose a case as IRIS.