title: Post-kala-azar dermal leishmaniasis mimicking leprosy relapse: a diagnostic dilemma.
abstract: OBJECTIVE
  Post-kala-azar dermal leishmaniasis (PKDL) is well recognized in the Indian subcontinent and is not infrequently confused with leprosy. The present report describes findings in an unusual case of PKDL.
  
  
  METHODS
  We report an adult male who presented with firm nodules on the face and extremities, along with hypopigmented macules on the neck with deformity and hypoesthesia over the right upper extremity. The patient had experienced similar lesions seven years previously and had used multibacillary multi-drug therapy for leprosy with complete resolution of the nodules.
  
  
  RESULTS
  At the current presentation, skin smears from ear lobes and nodules were negative on Ziehl-Neelsen staining. Histopathological examination revealed a dermal lymphohistiocytic infiltrate with plasma cells. Giemsa staining of a tissue smear revealed Leishmania donovani bodies, and an rK39 antigen test was positive. The patient responded well to oral miltefosine.
  
  
  CONCLUSIONS
  This case is noteworthy because the patient exhibited an unusual combination of healed leprosy sequelae and active PKDL lesions, which caused a diagnostic dilemma.
authors: Department of Dermatology and Venereology, ESIC (Employees' State Insurance Corp.) Postgraduate Institute of Medical Sciences and Research (PGIMSR), New Delhi, India.
authors: Shikha
authors: S
authors: Arora
authors: Paschal
authors: P
authors: D'Souza
authors: Mohammad A
authors: MA
authors: Haroon
authors: V
authors: V
authors: Ramesh
authors: Onkar
authors: O
authors: Kaur
authors: Raj Kumar
authors: RK
authors: Chandoke
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis* / Q000209:etiology*; D007898:Leishmaniasis, Visceral / Q000150:complications*; D007918:Leprosy / Q000175:diagnosis*; D008297:Male; D012008:Recurrence