Post-kala-azar dermal leishmaniasis mimicking leprosy: experience with 4 patients, with some unusual features in 1

We report on 4 cases of post-kala-azar dermal leishmaniasis (PKDL). History of kala-azar was available in all 4 patients. Slit-skin smears (SSS) for leishmania donovani (LD) bodies were negative in all 4. In 3 patients hypopigmented lesions were present over the face. Papules and nodules over his lips, tongue, scrotum and dactylitis were some unusual features observed in 1 patient. Histopathological examination showed LD bodies in 2 patients; histopathology was nonspecific in the other 2. All the patients were treated with sodium stibogluconate, 20 mg/kg/day. Infiltrated papules and nodules had subsided by 3 months, while hypopigmented macules took longer to improve. In 3 patients there had previously been a misdiagnosis as leprosy sufferers and they had been treated with antileprosy drugs. Clinical and histopathological differences between PKDL and leprosy are discussed.