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Case Reports
. 2023 Dec 18;23(1):885.
doi: 10.1186/s12879-023-08918-1.

A case report on para-kala-azar dermal leishmaniasis: an unresolved mystery

Md Mehedi Hasan  1 , Sanghita Banik Proma  2 , Md Saddam Hossain  3 , Md Arifuzzaman  4 , Naylla Islam  3 , Md Abu Bakar Siddique  5 , Amiruzzaman  3
Affiliations
Case Reports

A case report on para-kala-azar dermal leishmaniasis: an unresolved mystery

Md Mehedi Hasan et al. BMC Infect Dis. .

Abstract

Background: Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis that occurs 2-3 years after an apparently successful treatment of visceral leishmaniasis (VL). In rare cases, PKDL occurs concurrently with VL and is characterized by fever, splenomegaly, hepatomegaly or lymphadenopathy, and poor nutritional status and is known as Para-kala-azar dermal leishmaniasis (Para-KDL). Co-association of active VL in PKDL patients is documented in Africa, but very few case reports are found in South Asia. We present a case of Para-kala-azar Dermal Leishmaniasis (Para-KDL) in a 50-year-old male patient with a history of one primary Visceral Leishmaniasis (VL) and 2 times relapse of Visceral Leishmaniasis (VL). The patient presented with fever, skin lesions, and hepatosplenomegaly. Laboratory tests revealed LD bodies in the slit skin smear and splenic biopsy. The patient was treated with two cycles of Amphotericin B with Miltefosine in between cycles for 12 weeks to obtain full recovery.

Conclusion: This case report serves as a reminder that Para-kala-azar dermal leishmaniasis can develop as a consequence of prior visceral leishmaniasis episodes, even after apparently effective therapy. Since para-kala-azar is a source of infectious spread, endemics cannot be avoided unless it is effectively recognized and treated.

Keywords: PKDL; Para-kala-azar; Post-kala-azar dermal Leishmaniasis; VL; Visceral Leishmaniasis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Multiple hypopigmented maculopapular rash present on the body, mostly on the back of patient
Fig. 2
Fig. 2
Erythematous rash on feet of patient
Fig. 3
Fig. 3
Splenic smear shows lymphocytes, histiocytes and blood. Leishmania Donovani (LD) bodies are seen within and outside the cytoplasm of histiocytes
Fig. 4
Fig. 4
Slit skin smear section shows skin. The epidermis is thin and flat. The dermis reveals dense infiltration of histiocytes and lymphocytes, many of the histiocytes are packed with Leishmania Donovani (LD) bodies
Fig. 5
Fig. 5
Empty vials of Liposomal Amphotericin B after administration
See this image and copyright information in PMC

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