Post-kala-azar dermal leishmaniasis in Nepal

Background Post-kala-azar dermal leishmaniasis (PKDL) manifests as a skin e ruption after healing of visceral leishmaniasis (VL), either spontaneously or as a result of treatment. This study was undertaken to describe the demo graphic, clinical, and histopathologic features of PKDL in Nepal. Methods Demographic, clinical, microbiologic, and histopathologic features and response to treatment were studied in 22 patients with PKDL from April 1998 to March 2000. Results PKDL accounted for 0.13% of all new dermatologic cases. There were 13 (59.1%) males and nine (40.9%) females. A past history of kala-azar was present in all but one patient. A family history of kala-azar was noted in eight (36.4%) patients. All patients presented with multiple types of lesio n, except for two in whom only macular lesions were seen. Oral lesions in t he form of nodules and plaques were seen in four patients. Generalized lymp hadenopathy was present in five patients. Slit skin smears revealed Leishma n-Donovan bodies (LDBs) in nine (40.9%) patients. In macular lesions, there was a sparse infiltrate of plasma cells, lymphocytes, or histiocytes in th e upper dermis. There was a dense chronic inflammatory infiltrate comprisin g plasma cells, lymphocytes, histiocytes, and epithelioid cells in the enti re dermis from papules, plaques, or nodules. Giemsa staining of biopsy spec imens revealed LDBs in seven (38.9%) patients only. Fine needle aspiration from epitrochlear lymph nodes in two patients demonstrated LDBs. All patien ts responded well to treatment with minimal side-effects. Conclusions This study emphasizes the need to be aware of the possibility o f cases of PKDL in endemic regions of leprosy, as the conditions may be dif ficult to distinguish clinically and histopathologically.