[Kala-azar in immunosuppressed patients. Apropos of a case disclosed by skin lesions]

Abstract

Kala-azar was revealed by skin lesions in a patient treated for recurrent Hodgkin's disease. These lesions, extremely discreet, consisted of papules on the forehead and in the peribuccal area. Histological examinations initially showed nodular infiltration of the dermis with very few Leishman-Donovan bodies; subsequently, foamy, Virchow-type histiocytes appeared, and Leishman-Donovan bodies became numerous. This clinical and histological similarity with leprosy has already been noted for post-kala-azar dermal leishmaniasis which is frequent in India and in Ethiopia. Skin lesions in kala-azar appear to be exceptional since they were not observed in the 7 cases of kala-azar in immunodepressed patients previously published. The fact that they are discreet may account for their apparent rareness. Easily accessible, they make it possible to diagnose visceral leishmaniasis--an often difficult diagnosis in these patients owing to the underlying disease. Immunodepression has little influence on the clinical and biological manifestations of kala-azar, but reserves must be made concerning the usual criteria for cure.