Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh.
Government Employee Hospital, Dhaka, Bangladesh.
BMC Infect Dis. 2023 Dec 18;23(1):885. doi: 10.1186/s12879-023-08918-1.
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.
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.
黑热病后皮肤利什曼病（PKDL）是一种皮肤病，发生在内脏利什曼病（VL）治疗后 2-3 年。在罕见情况下，PKDL 与 VL 同时发生，其特征为发热、脾肿大、肝肿大或淋巴结病以及营养不良，并称为副黑热病皮肤利什曼病（Para-KDL）。在非洲，有记录表明 PKDL 患者并发活动性 VL，但在南亚，很少有病例报告。我们报告了一名 50 岁男性患者的 Para-kala-azar 皮肤利什曼病（Para-KDL）病例，该患者有一次原发性内脏利什曼病（VL）病史和两次内脏利什曼病（VL）复发。该患者表现为发热、皮肤损伤和肝脾肿大。实验室检查显示皮肤划痕液中有 LD 体和脾活检中的利什曼原虫。该患者接受了两个疗程的两性霉素 B 和米替福新治疗，疗程之间间隔 12 周，以获得完全康复。
本病例报告提醒人们，副黑热病皮肤利什曼病可由先前的内脏利什曼病发作引起，即使在经过明显有效的治疗后也是如此。由于副黑热病是传染性传播的来源，除非能够有效识别和治疗，否则无法避免流行。
