Frances C, Merle Beral H, Franceschini P, Lessana-Leibowitch M, Escande J P
Presse Med. 1984 Nov 10;13(40):2433-6.
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.
在一名接受复发性霍奇金病治疗的患者中，通过皮肤病变确诊了黑热病。这些病变极为隐匿，表现为前额和颊周区域的丘疹。组织学检查最初显示真皮有结节状浸润，利什曼-多诺万小体极少；随后，出现了泡沫状的维尔肖型组织细胞，利什曼-多诺万小体数量增多。与麻风病的这种临床和组织学相似性在印度和埃塞俄比亚常见的黑热病后皮肤利什曼病中已有记载。黑热病中的皮肤病变似乎很罕见，因为在先前发表的7例免疫抑制患者的黑热病病例中未观察到。它们隐匿的特点可能解释了其明显的罕见性。由于易于获取，这些病变使得内脏利什曼病的诊断成为可能——鉴于基础疾病，对这些患者来说这往往是一项困难的诊断。免疫抑制对黑热病的临床和生物学表现影响不大，但在通常的治愈标准方面必须有所保留。
