Atypical post kala azar dermal leishmaniasis with "muzzle area" swelling

Area of Science:

• Dermatology
• Infectious Diseases
• Parasitology

Background:

• Recurrent facial swelling and intermittent fever in a 50-year-old male.
• Previous treatments included antibiotics, steroids, and antitubercular therapy without resolution.

Purpose of the Study:

• To diagnose and manage a challenging case of suspected post-kala azar dermal leishmaniasis.
• To highlight diagnostic methods for cutaneous leishmaniasis.

Main Methods:

• Skin biopsy for histopathology (granulomatous infiltration, negative for AFB and Leishmania donovan bodies).
• Immunochromatography test for rK39 antigen (positive).
• Polymerase chain reaction (PCR) for Leishmania DNA (positive).

Main Results:

• Histopathology showed non-specific granulomatous inflammation.
• Serological and molecular tests confirmed Leishmania infection.
• Diagnosis of post-kala azar dermal leishmaniasis was established.

Conclusions:

• Post-kala azar dermal leishmaniasis can present with atypical facial swelling.
• Combined serological and molecular diagnostics are crucial for accurate diagnosis.
• Treatment with sodium stibogluconate was effective.