We report a 23-year-old male with lepromatous leprosy atypically presenting with 5-year history of asymptomatic, verrucous papules, and nodules. Human Immunodeficiency Virus (HIV) testing was positive with depressed CD4 count. In HIV/leprosy co-infection, most of the documented patients were diagnosed with paucibacillary leprosy as immune reconstitution disease (IRD) from treatment-induced immunological recovery. Rarely, multibacillary lepromatous leprosy is encountered in the setting of untreated, severe immunodeficiency. Atypical clinical presentation warrants investigation for concurrent HIV infection.