Post kala-azar dermal leishmaniasis masquerading as lepromatous leprosy in a treated case of Hansen′s : A diagnostic dilemma

Abstract

Post kala-azar dermal leishmaniasis (PKDL), a sequelae of kala-azar is well recognized in our country. The diagnosis is frequently confused with leprosy causing a diagnostic dilemma. We report an adult male who presented with firm nodules on the face and the extremities along with hypopigmented macules on the neck with deformity and hypoaesthesia over the right upper extremity. The patient had similar nodules over the face and weakness in right hand seven years back for which he took multidrug therapy (MB-MDT) for leprosy with complete resolution of the nodules. At present the patient had enlarged peripheral nerves along with hypoaesthesia over right hand & forearm. The slit-skin smears were negative for acid-fast bacilli. The histopathological examination revealed dermal lymphohistiocytic infiltrate with plasma cells. The patient admitted taking treatment for kala-azar 20 years back. Slit smears on Giemsa staining showed Leishmania Donovani bodies. rK39 antigen testing gave positive result. We are reporting this case since the patient who initially had leprosy developed PKDL a few years later with similar lesions causing a diagnostic dilemma.

Keywords

• PKDL
• Leishmaniasis
• Leprosy
• Relapse