Distinguishing post-kala-azar dermal leishmaniasis from leprosy: experience in the Sudan

In this study 4 patients were post-kala-azar dermal leishmaniasis (PKDL), whose lesions were similar to those of lepromatous and borderline leprosy, are described. In 2 patients there was no previous history of kala-azar but they were residents of an area of known endemic kala-azar. Lack of proper clinical and laboratory assessment was behind the failure to diagnose PKDL. Consequently the patients were treated with antileprosy drugs without proof of leprosy. The 3rd and 4th patients, though suspected clinically of leprosy, were correctly diagnosed as PKDL with adequate history, clinical assessment and appropriate laboratory investigations. The salient points in distinguishing PKDL from leprosy are described and discussed.