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Post‐kala‐azar dermal leishmaniasis mimicking leprosy relapse: a diagnostic dilemma
Author(s) -
Arora Shikha,
D'Souza Paschal,
Haroon Mohammad A.,
Ramesh V.,
Kaur Onkar,
Chandoke Raj Kumar
Publication year - 2014
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.12299
Subject(s) - miltefosine , medicine , leprosy , dermatology , leishmaniasis , pathology , visceral leishmaniasis , biopsy , clofazimine
Objectives Post‐kala‐azar dermal leishmaniasis ( PKDL ) is well recognized in the Indian subcontinent and is not infrequently confused with leprosy. The present report describes findings in an unusual case of PKDL . Methods We report an adult male who presented with firm nodules on the face and extremities, along with hypopigmented macules on the neck with deformity and hypoesthesia over the right upper extremity. The patient had experienced similar lesions seven years previously and had used multibacillary multi‐drug therapy for leprosy with complete resolution of the nodules. Results At the current presentation, skin smears from ear lobes and nodules were negative on Z iehl– N eelsen staining. Histopathological examination revealed a dermal lymphohistiocytic infiltrate with plasma cells. Giemsa staining of a tissue smear revealed L eishmania donovani bodies, and an r K 39 antigen test was positive. The patient responded well to oral miltefosine. Conclusions This case is noteworthy because the patient exhibited an unusual combination of healed leprosy sequelae and active PKDL lesions, which caused a diagnostic dilemma.