A case of miltefosine responsive pleomorphic post kala-azar dermal leishmaniasis

Abstract

We identified a case of pleomorphic post kala-azar dermal leishmaniasis (PKDL) with different types of skin lesions in different stages of development. He was earlier diagnosed as a case of lepromatous leprosy on the basis of his skin picture and was treated with anti-leprotic drugs for one year in his native village, but without any improvement. We diagnosed him as a case of PKDL on clinical grounds, skin biopsy showing LD bodies and positive DNA-PCR from different types of skin lesions. Now he improved dramatically with miltefosine in standard dose for one month; and was continued on the medicine for the recommended duration. Case proper: A 30-year-old tribal farmer from a remote village of Bihar; a state in eastern India, known to be endemic for leishmaniasis, presented with multiple painless, nonpruritic, progressively increasing hypopigmented macular, papular (Fig. 1), plaque-type, nodular and nodules with central scar over different areas of his body including face, back, upper and lower extremities (Fig. 2A, B) for last one and half years. He first attended a nearby government hospital and was treated there as a case of lepromatous leprosy with multi-drug therapy for one year without any improvement. He presented to us with his progressing skin lesions. On enquiry, he gave a history of prolonged fever with abdominal swelling ten years