Mukherjee A, Ramesh V, Misra R S
Institute of Pathology (ICMR), Safdarjang Hospital, New Delhi, India.
J Cutan Pathol. 1993 Aug;20(4):320-5. doi: 10.1111/j.1600-0560.1993.tb01269.x.
Post-kala-azar dermal leishmaniasis (PKDL) is caused by the protozoan parasite, Leishmania donovani, and is seen in patients with history of having been treated earlier for the visceral disease form, kala-azar, caused by the same organism. The findings from 18 patients with PKDL are described in this study. The skin manifestations ranged from hypopigmented macules to infiltrated plaques and nodules. Histopathologic examination revealed a cellular infiltrate of lymphocytes, plasma cells, and macrophages. The macrophages were scattered amidst the infiltrate without any localization. In hypopigmented lesions, the infiltrate was confined to the perivascular region in the superficial dermis and was composed mainly of lymphocytes and few plasma cells. In the nodular lesions, the infiltrate occupied the entire thickness of the dermis. Leishman-Donovan bodies were scarce and identified in 16 cases after a prolonged search of Weigert's iron hematoxylin-stained sections. In 2 cases, Leishman-Donovan bodies were not demonstrable. Electronmicroscopic study revealed parasitized macrophages which showed no structural evidence of activation despite the active cellular response around them. The fine structure of the parasites in the histiocytes was also well maintained. This unusual tropical dermatosis is a unique example of change in organotropism of a parasite associated with a change in the host response.
黑热病后皮肤利什曼病（PKDL）由原生动物寄生虫杜氏利什曼原虫引起，见于曾接受过针对由同一病原体引起的内脏疾病型黑热病治疗的患者。本研究描述了18例PKDL患者的研究结果。皮肤表现从色素减退斑到浸润性斑块和结节不等。组织病理学检查显示淋巴细胞、浆细胞和巨噬细胞浸润。巨噬细胞散在于浸润细胞中，无任何定位。在色素减退性病变中，浸润局限于浅表真皮的血管周围区域，主要由淋巴细胞和少量浆细胞组成。在结节性病变中，浸润占据真皮全层。利什曼 - 多诺万小体稀少，在对魏格特铁苏木精染色切片进行长时间查找后，在16例中得以鉴定。在2例中未发现利什曼 - 多诺万小体。电子显微镜研究显示被寄生的巨噬细胞，尽管其周围有活跃的细胞反应，但未显示出激活的结构证据。组织细胞内寄生虫的精细结构也保存良好。这种不寻常的热带皮肤病是寄生虫器官嗜性改变与宿主反应改变相关的独特例子。
