Singh Amresh Kumar, Kumar Ankur, Pandey Jayesh, Gaur Vivek, Tripathi Pratima, Adhikari Indra Prasad
Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh 273013, India.
Department of Biochemistry, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh 273013, India.
Case Rep Dermatol Med. 2021 Mar 8;2021:5526435. doi: 10.1155/2021/5526435. eCollection 2021.
Leishmaniasis was first described in 1824, in the Jessore district of Bengal (now Bangladesh) and more prevalent in Bihar, Uttar Pradesh, Jharkhand, and West Bengal. The disease is associated with depressed cellular immunity. Tinea is a fungal infection of the skin, which can become more extensively pathogenic particularly in patients with depressed cell-mediated immunity. Regulatory T cells and Th17 cells have been shown to be responsible for post-kala-azar dermal leishmaniasis (PKDL). We present a rare case of a 52-year-old house wife with a history of recurrent itching, depigmentation of the skin of extremities, and loss of appetite for 2-3 months followed by progressive spread of such lesion all over the body in an apparently healthy female. On examination, there were many hypopigmented scaly lesions mainly over the extensor aspect of the body. Skin lesions were characteristics of tinea infection with or without PKDL. A diagnosis of PKDL with tinea was made based on the history of kala-azar and on the skin slit smear for amastigote forms, test, and KOH mount. Routine blood investigations showed negative serology for HIV and lower normal CD4+T counts. The patient was advised for treatment on systemic antifungal therapy with antihistaminics and later with miltefosine. We have highlighted that PKDL, although uncommon, is a distinct manifestation of VL. In our case study, we also tried to find the reason of coinfection; this was probably due to the depressed cellular immunity, skin abruptions, and acquired dermatophytic infection which is prevalent and associated with lower CD4+ T cell count.
利什曼病于1824年首次在孟加拉的杰索尔地区（现属孟加拉国）被描述，在比哈尔邦、北方邦、贾坎德邦和西孟加拉邦更为普遍。该疾病与细胞免疫抑制有关。癣是一种皮肤真菌感染，在细胞介导免疫抑制的患者中尤其容易变得更具致病性。调节性T细胞和Th17细胞已被证明与黑热病后皮肤利什曼病（PKDL）有关。我们报告了一例罕见病例，一名52岁的家庭主妇，有反复瘙痒、四肢皮肤色素脱失和食欲不振2 - 3个月的病史，随后这种病变在一名看似健康的女性身上逐渐蔓延至全身。检查时，主要在身体伸侧有许多色素减退的鳞屑性病变。皮肤病变具有癣感染伴或不伴PKDL的特征。根据黑热病病史、皮肤涂片查找无鞭毛体形式、检测及氢氧化钾封片，诊断为PKDL合并癣。常规血液检查显示HIV血清学阴性且CD4 + T细胞计数略低于正常。建议患者接受全身抗真菌治疗并加用抗组胺药，随后使用米替福新进行治疗。我们强调，PKDL虽然不常见，但却是内脏利什曼病的一种独特表现。在我们的病例研究中，我们还试图找出合并感染的原因；这可能是由于细胞免疫抑制、皮肤破损以及获得性皮肤癣菌感染，后者很常见且与较低的CD4 + T细胞计数有关。
