Atypical presentation of post-kala-azar dermal leishmaniasis

Abstract

An 80-year-old man, from an area in Bangladesh where visceral leishmaniasis is endemic, presented at our hospital in June, 2016, reporting widespread swelling and a history of papulonodular lesions for the past 2 years. In 2014, the patient sought medical attention for skin thickening and several subcutaneous papules and nodules of varying sizes, which had gradually developed on the dorsum of the foot, and then disseminated to both legs. The patient gave no history of fever or other systemic symptoms at any time of illness. He was initially diagnosed with leprosy and treated for a year with a daily oral dose of clofazimine (50 mg) and dapsone (100 mg), and once a month with clofazimine (300 mg) and rifampicin (600 mg), also orally. Symptoms did not improve, leading the physician to suspect lymphatic filariasis because of bilateral and extensive non-pitting oedema of the legs, and the patient was treated with a daily dose of diethylcarbamazine (6 mg/kg) for 12 days.