Post Kala-Azar Dermal Leishmaniasis: Clinical Features and Differential Diagnosis

Abstract

Post kala-azar dermal leishmaniasis (PKDL) is a mucocutaneous disease usually seen in apparently cured, inadequately treated or untreated cases of visceral leishmaniasis and is endemic to many parts of India, Nepal, Bangladesh, and eastern Africa (Sudan, Ethiopia, Kenya). The disease usually manifests as a variable combination of hypopigmented patches, erythematous succulent papulo-plaques, and nodular lesions on the face and upper body and sometimes extending on the extremities, genitalia, and tongue. Atypical morphology and presentations are not uncommon, especially in endemic areas, which include photosensitivity, verrucous, hypertrophic, xanthomatous, and ulcerative lesions. Recognition of spectrum of mucocutaneous changes helps physicians in early initiation of treatment and in reducing disease transmission in the community. The differential diagnosis depends on the pattern of manifestations, but lepromatous leprosy is the closest mimicker. Since PKDL does not cause significant morbidity, at least initially, but the affected patients continue to act as a reservoir of the disease, active case detection is required to identify cases early to control the disease transmission in the community.

Keywords: Active surveillance; India; Leishmania donovani; Sudan; para kala-azar dermal leishmaniasis; post kala-azar dermal leishmaniasis; visceral leishmaniasis.

Figure 1

Monomorphic macular lesions of PKDL on the trunk

Figure 2

Monomorphic macular lesions which have coalesced together

Figure 3

Polymorphic lesions with guttate hypopigmented macules on trunk, plaques on left forearm, and nodules on abdomen

Figure 4

Polymorphic lesions with macules on back, papules on nape of neck, and nodules on earlobe

Figure 5

Papular and nodular lesions developing de-novo near the elbow and wrist

Figure 6

Macules developing around “muzzle area of face” and then spreading to rest of face

Figure 7

Papules and nodules on the “muzzle-area of face”

Figure 8

Macules spreading on the lower extremities

Figure 9

Nodules spreading on the dorsa of hands

Figure 10

Nodules extending onto the palms

Figure 11

Nodules on the foot

Figure 12

Papule developing over a patch near the lower lip

Figure 13

Nodules developing over the patch near the elbow

Figure 14

Papules and succulent nodules over the nose

Figure 15

Papules and succulent nodules over the nose and ear

Figure 16

Succulent nodules over ears

Figure 17

Papules and succulent nodules over the entire face

Figure 18

Hypopigmented patches and papules occupying the anterior and posterior axillary folds but spare a small island of skin near the vault of axilla

Figure 19

Photosensitivity with nodules on nose and tongue

Figure 20

Photosensitivity was the presenting feature in the case who went on to develop hypopigmented patches later

Figure 21

Spontaneous ulceration developing on top of nodules in PKDL which became secondarily infected

Figure 22

Nodules on the tongue and upper lip

Figure 23

Nodules on the lips and tip of tongue

Figure 24

Nodules on the genitals with confluent hypopigmented patches on the thighs

Figure 25

Nodules on the genitals

Figure 26

Hypopigmented macules on the covered area of back in a young girl