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Histopathology of Post Kala-azar Dermal Leishmaniasis
1Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India.
Insights
Histopathology of post kala-azar dermal leishmaniasis (PKDL) reveals diverse dermal infiltrates. Characteristic features, like follicular plugging in nodules, aid diagnosis even without Leishman-Donovan bodies (LDB).
Area of Science:
- Dermatology
- Parasitology
- Pathology
Background:
- Post kala-azar dermal leishmaniasis (PKDL) presents with varied clinical lesions.
- Histopathological examination of skin biopsies is crucial for diagnosing PKDL.
Purpose of the Study:
- To describe the histopathological features of different PKDL lesions.
- To highlight diagnostic clues and differential diagnoses in PKDL histopathology.
Main Methods:
- Analysis of histopathological findings from PKDL skin biopsies.
- Comparison of Indian and African PKDL histomorphology.
Main Results:
- Dermal infiltrates vary in cellular composition (lymphocytes, histiocytes, plasma cells) and density with lesion severity.
- Leishman-Donovan bodies (LDB) are infrequently found in skin biopsies but more common in mucosal lesions.
- Nodular lesions show characteristic follicular plugging and dense lymphohistiocytic infiltrate with plasma cells, suggestive of PKDL.
- Chronic plaques may exhibit Russell bodies and xanthoma-like changes.
- Histopathology can mimic leprosy and other granulomatous dermatoses.
- African PKDL often shows epithelioid granulomas with giant cells, unlike Indian PKDL.
Conclusions:
- PKDL histopathology is diverse and lesion-dependent.
- Specific histomorphological features, particularly in nodules, are highly suggestive of PKDL.
- Awareness of mimicry with other dermatoses and regional variations (Indian vs. African PKDL) is essential for accurate diagnosis.
Abstract:
The various lesions seen in the clinical presentation of post kala-azar dermal leishmaniasis (PKDL) are reflected in the histopathology of the type of lesion biopsied. The cells that form the dermal infiltrate include lymphocytes, histiocytes, and plasma cells in varying proportions. The infiltrate, which is mild and confined to the superficial dermis in macular lesion becomes denser with the increasing severity of the lesion. Leishman-Donovan bodies (LDB) in general are rarely demonstrable in macules and somewhat infrequently in the rest, though at times they may be numerous; mucosal lesions offer a greater chance of visualizing LDB than biopsies from the skin. A characteristic histomorphology in nodules is prominent follicular plugging with a dense plasma cell-rich lymphohistiocytic dermal infiltrate that shows an abrupt cut-off in the lower dermis, an appearance highly suggestive of PKDL even in the absence of LDB. Russell bodies within plasma cells, vascular changes, and xanthoma-like hue have been seen in plaques from chronic PKDL. The histopathologic picture in some may also mimic that seen in tuberculoid and lepromatous leprosy, and other granulomatous dermatoses. In contrast to Indian PKDL, epithelioid cell granulomas with giant cells are more common in African PKDL, and vascular changes are rare though neuritis showing LDB has been described.
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