Para Kala-Azar Dermal Leishmaniasis: A Case Report.

Area of Science:

• Infectious Diseases
• Dermatology
• Hepatology

Background:

• Visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL) are distinct clinical manifestations of Leishmania infection.
• Concomitant VL and PKDL, termed Para-kala-azar dermal Leishmaniasis, is an uncommon presentation.
• Chronic Hepatitis B virus (HBV) infection can influence immune responses and disease progression in parasitic infections.

Observation:

• A patient with chronic HBV infection presented with an abdominal lump and multiple maculopapular skin lesions.
• The patient was diagnosed with concomitant visceral leishmaniasis and post-kala-azar dermal leishmaniasis.
• Initial treatment with sodium stibogluconate, a first-line antimonial drug, proved ineffective.

Findings:

• The patient exhibited resistance to standard sodium stibogluconate therapy for Para-kala-azar dermal leishmaniasis.
• Successful treatment was achieved using liposomal Amphotericin-B, an alternative antifungal and antileishmanial agent.
• This case underscores the potential for complex interactions between chronic HBV infection and leishmaniasis.

Implications:

• Liposomal Amphotericin-B should be considered for managing drug-resistant Para-kala-azar dermal leishmaniasis, especially in immunocompromised patients.
• Further research is warranted to understand the impact of chronic HBV on leishmaniasis treatment outcomes.
• This case contributes to the literature on rare presentations of leishmaniasis and challenges in its management.