Post-kala-azar dermal leishmaniasis and leprosy: case report and literature review

Autor(es)

Bianconcini Trindade, Maria Angela ^{[1, 2, 3]} ; da Cruz Silva, Lana Luiza ^[2] ; Almeida Braz, Lucia Maria ^[4] ; Amato, Valdir Sabbaga ^[5] ; Naafs, Bernard ^[6] ; Sotto, Mirian Nacagami ^[7]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Inst Med Trop, Hosp Clin, Lab Invest Med LIM 56, Imunodermatol, BR-05403900 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Dept Dermatol, Fac Med, BR-05403900 Sao Paulo - Brazil

^[3] Secretaria Estado Saude Sao Paulo, Posgrad Inst Saude, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Lab Parasitol, Inst Med Trop, BR-05403900 Sao Paulo - Brazil

^[5] Univ Sao Paulo, Dept Doencas Infecciosas, Fac Med, BR-05403900 Sao Paulo - Brazil

^[6] Stichting Global Dermatol, Munnekeburen - Netherlands

^[7] Univ Sao Paulo, Dept Patol & Dermatol, Fac Med, BR-05403900 Sao Paulo - Brazil

• Tipo de documento: Artigo de Revisão
• Fonte: BMC INFECTIOUS DISEASES; v. 15, NOV 23 2015.
• Citações Web of Science: 3

Resumo

Background: Post-kala-azar dermal leishmaniasis (PKDL) is a dermal complication of visceral leishmaniasis (VL), which may occur after or during treatment. It has been frequently reported from India and the Sudan, but its occurrence in South America has been rarely reported. It may mimic leprosy and its differentiation may be difficult, since both diseases may show hypo-pigmented macular lesions as clinical presentation and neural involvement in histopathological investigations. The co-infection of leprosy and VL has been reported in countries where both diseases are endemic. The authors report a co-infection case of leprosy and VL, which evolved into PKDL and discuss the clinical and the pathological aspects in the patient and review the literature on this disease. Case presentation: We report an unusual case of a 53-year-old female patient from Alagoas, Brazil. She presented with leprosy and a necrotizing erythema nodosum, a type II leprosy reaction, about 3 month after finishing the treatment (MDT-MB) for leprosy. She was hospitalized and VL was diagnosed at that time and she was successfully treated with liposomal amphotericin B. After 6 months, she developed a few hypo-pigmented papules on her forehead. A granulomatous inflammatory infiltrate throughout the dermis was observed at histopathological examination of the skin biopsy. It consisted of epithelioid histiocytes, lymphocytes and plasma cells with the presence of amastigotes of Leishmania in macrophages (Leishman's bodies). The diagnosis of post-kala-azar dermal leishmaniasis was established because at this time there was no hepatosplenomegaly and the bone marrow did not show Leishmania parasites thus excluding VL. About 2 years after the treatment of PKDL with liposomal amphotericin B the patient is still without PKDL lesions. Conclusion: Post-kala-azar dermal leishmaniasis is a rare dermal complication of VL that mimics leprosy and should be considered particularly in countries where both diseases are endemic. A co-infection must be seriously considered, especially in patients who are non-responsive to treatment or develop persistent leprosy reactions as those encountered in the patient reported here. (AU)

• Processo FAPESP: 10/50304-8 - Diagnóstico da leishmaniose visceral: pesquisa do parasita no sangue periférico por concentração e associação as técnicas clássicas e método molecular (kDNA)
• Beneficiário: Lúcia Maria Almeida Braz
• Modalidade de apoio: Auxílio à Pesquisa - Regular