title: Histopathological characteristics of post kala-azar dermal leishmaniasis: a series of 88 patients.
abstract: BACKGROUND
  Post kala azar dermal leishmaniasis (PKDL) is a sequel to visceral leishmaniasis or kala azar seen predominantly in the Indian subcontinent and Africa. Histopathological descriptions of the condition are limited.
  
  
  METHODS
  Biopsies of 88 skin and 16 mucosal lesions were evaluated for histopathological findings on formalin-fixed, paraffin-embedded tissues.
  
  
  RESULTS
  There were 71 (80.7%) males and 17 (19.3%) females with a mean age of 24.8 and 28.5 years, respectively. A past history of kala azar was present in 64 (72.7%) patients and post kala azar dermal leishmaniasis developed a mean of 6.2 years after visceral leishmaniasis. Of the biopsies studied, the clinical lesions were macular in 14 (15.9%), papulo-nodular in 32 (36.3%) and showed both macules and papulo-nodules in 42 (47.8%). Follicular plugging was a common epidermal finding. A clear Grenz zone was frequently noted. The dermal infiltrates were arranged mainly in three patterns: superficial perivascular infiltrates in 16 (18.1%), perivascular and perifollicular infiltrates in 24 (27.3%) and diffuse infiltrates in 41 (46.6%) biopsies. Leishman-Donovan (LD) bodies were noted in 13 (44.9%) of 69 cases on slit-skin smear and in 25 (28.4%) of 88 biopsies. In 16 patients, where both skin and mucosal biopsies were available, LD bodies were identified in 10 (62.5%) mucosal biopsies as compared to 3 (18.7%) skin biopsies.
  
  
  CONCLUSIONS
  The retrospective nature of the study and the lack of controls were limitations.
  
  
  CONCLUSIONS
  The various histomorphological patterns of post kala azar dermal leishmaniasis are a useful clue to the diagnosis even when LD bodies have not been detected. This study also suggests that LD bodies are more frequently seen in mucosal biopsies in comparison to cutaneous biopsies.
authors.affiliation: Department of Pathology, National Institute of Pathology ICMR, Safdarjung Hospital Campus, New Delhi, India.
authors.forename: Avninder
authors.initials: A
authors.lastname: Singh
authors.forename: V
authors.initials: V
authors.lastname: Ramesh
authors.forename: M
authors.initials: M
authors.lastname: Ramam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D005260:Female; D006801:Humans; D007893:Leishmania donovani; D007897:Leishmaniasis, Mucocutaneous / Q000175:diagnosis / Q000469:parasitology* / Q000473:pathology*; D007898:Leishmaniasis, Visceral / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology*; D009092:Mucous Membrane / Q000473:pathology; D010413:Penis; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D055815:Young Adult