Case Report: An Atypical Case of Post-Kala-Azar Dermal Leishmaniasis with Ulcers and Verrucous Lesions: Clinical and Therapeutic Implications

Sinu Rose Mathachan Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India;

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Ananta Khurana Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India;

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Abhinav Bansal Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India;

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Monil Singhai Centre for Arboviral and Zoonotic Diseases, National Centre for Disease Control, New Delhi, India;

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Ritu Kumari Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India;

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Kabir Sardana Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India;

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Vishesh Sood Centre for Arboviral and Zoonotic Diseases, National Centre for Disease Control, New Delhi, India;

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Preeti Khatri Centre for Arboviral and Zoonotic Diseases, National Centre for Disease Control, New Delhi, India;

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Itu Singh Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, New Delhi, India

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ABSTRACT.

About 75% cases of post-kala-azar dermal leishmaniasis (PKDL) occur in India. Although the classic description of PKDL is the progression from initial hypopigmented macular lesions to papules to plaques and nodular lesions, atypical morphologies are also seen and are easily missed or misdiagnosed. We report a case of a 27-year-old man who presented to us with multiple acral ulcers and verrucous lesions for 5 years. A diagnosis of PKDL was made based on slit skin smear, histopathology, and quantitative polymerase chain reaction. The patient was given combination therapy with four doses of liposomal amphotericin B and miltefosine 50 mg twice daily for 45 days. In this report, we discuss unusual morphologies of PKDL, the pathway to the diagnosis, and the therapeutic options available along with their efficacy.

Author Notes

Authors’ addresses: Sinu Rose Mathachan, Ananta Khurana, Abhinav Bansal, Ritu Kumari, and Kabir Sardana, Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India, E-mails: sinurose@gmail.com, drananta2014@gmail.com, abhinavbansal866@gmail.com, ritu64026@gmail.com, and kabirijdvl@gmail.com. Monil Singhai, Vishesh Sood, and Preeti Khatri, Centre for Arboviral and Zoonotic Diseases, National Centre for Disease Control, New Delhi, India, E-mails: drmonil@gmail.com, visheshsood@outlook.com, and visheshsood@outlook.com. Itu Singh, Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, New Delhi, India, E-mail: itusingh@gmail.com.

Address correspondence to Ananta Khurana, Department of Dermatology, Venereology and Leprosy, ABVIMS & Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Rd., Connaught Place, New Delhi, Delhi 110001, India. E-mail: drananta2014@gmail.com
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