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

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorTRINDADE, Maria Angela Bianconcini
dc.contributor.authorSILVA, Lana Luiza da Cruz
dc.contributor.authorBRAZ, Lucia Maria Almeida
dc.contributor.authorAMATO, Valdir Sabbaga
dc.contributor.authorNAAFS, Bernard
dc.contributor.authorSOTTO, Mirian Nacagami
dc.date.accessioned2016-02-11T14:09:31Z
dc.date.available2016-02-11T14:09:31Z
dc.date.issued2015
dc.description.abstractBackground: 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.
dc.description.indexMEDLINE
dc.description.sponsorshipSao Paulo Research Foundation (FAPESP) [2010/50304-8]
dc.identifier.citationBMC INFECTIOUS DISEASES, v.15, article ID 543, 8p, 2015
dc.identifier.doi10.1186/s12879-015-1260-x
dc.identifier.issn1471-2334
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/12709
dc.language.isoeng
dc.publisherBIOMED CENTRAL LTD
dc.relation.ispartofBMC Infectious Diseases
dc.rightsopenAccess
dc.rights.holderCopyright BIOMED CENTRAL LTD
dc.subjectPost-kala-azar dermal leishmaniasis
dc.subjectVisceral leishmaniasis
dc.subjectLeprosy
dc.subjectLeprosy reactions
dc.subject.otherpredict subsequent development
dc.subject.othervisceral leishmaniasis
dc.subject.othercutaneous leishmaniasis
dc.subject.otherdiagnosis
dc.subject.othersudan
dc.subject.otherreactivation
dc.subject.otherinvolvement
dc.subject.othermiltefosine
dc.subject.otherfeatures
dc.subject.othermucosal
dc.subject.wosInfectious Diseases
dc.titlePost-kala-azar dermal leishmaniasis and leprosy: case report and literature review
dc.typearticle
dc.type.categoryreview
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryHolanda
hcfmusp.affiliation.countryisonl
hcfmusp.author.externalNAAFS, Bernard:Stichting Global Dermatol, Munnekeburen, Netherlands
hcfmusp.citation.scopus16
hcfmusp.contributor.author-fmusphcMARIA ANGELA BIANCONCINI TRINDADE
hcfmusp.contributor.author-fmusphcLANA LUIZA DA CRUZ SILVA
hcfmusp.contributor.author-fmusphcLUCIA MARIA ALMEIDA BRAZ
hcfmusp.contributor.author-fmusphcVALDIR SABBAGA AMATO
hcfmusp.contributor.author-fmusphcMIRIAN NACAGAMI SOTTO
hcfmusp.description.articlenumber543
hcfmusp.description.volume15
hcfmusp.origemWOS
hcfmusp.origem.pubmed26592919
hcfmusp.origem.scopus2-s2.0-84947917048
hcfmusp.origem.wosWOS:000365288000001
hcfmusp.publisher.cityLONDON
hcfmusp.publisher.countryENGLAND
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