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A 31-year-old man from Jharkhand and a known case of PLHIV on ART for 8 years presented with a history of hypopigmented lesions over the neck, upper back and bilaterally on upper limbs for the past 5-6 years which has been gradually progressing. He mentioned using topical medications but had recurrence. A bone marrow and skin biopsy was sent to the laboratory for HPE, PCR and microscopic examination.
- What is the diagnosis?
- What is the mode of acquisition?
- What is the treatment of choice?
Case answer – Posted on: 16-Sep-2024
- What is the diagnosis?
Post Kala-azar dermal Leishmaniasis (PKDL). The Leishman-Donovan (LD) bodies seen in the skin smear are oval, and measures 3-5um in size and are the amastigote form of the parasite (dot and dash appearance of nucleus and kinetoplast). These are usually seen in infected endothelial cells - What is the mode of acquisition?
PKDL is a non-ulcerative mucocutaneous disease occurring in patients with cured, inadequately treated or untreated cases of visceral leishmaniasis. In addition, the choice of treatment, dose, duration of treatment for VL can also influence the development of PKDL. - What is the treatment of choice?
The recommended treatment is Liposomal Amphotericin B in case of HIV co-infected individuals. In cases of PKDL without HIV co-infection, amphotericin B 1mg/kg body weight per day over 4 months is recommended. (Ref:https://iris.who.int/bitstream/handle/10665/354703/9789240048294-eng.pdf?sequence=1)