title: Post-kala-azar dermal leishmaniasis and leprosy: case report and literature review.
abstract: BACKGROUND
  Post-kala-azar dermal leishmaniasis (PKDL) is a dermal complication of visceral leishmaniasis (VL), which may occur after or during treatment. It has been frequently reported from India and the Sudan, but its occurrence in South America has been rarely reported. It may mimic leprosy and its differentiation may be difficult, since both diseases may show hypo-pigmented macular lesions as clinical presentation and neural involvement in histopathological investigations. The co-infection of leprosy and VL has been reported in countries where both diseases are endemic. The authors report a co-infection case of leprosy and VL, which evolved into PKDL and discuss the clinical and the pathological aspects in the patient and review the literature on this disease.
  
  
  METHODS
  We report an unusual case of a 53-year-old female patient from Alagoas, Brazil. She presented with leprosy and a necrotizing erythema nodosum, a type II leprosy reaction, about 3 month after finishing the treatment (MDT-MB) for leprosy. She was hospitalized and VL was diagnosed at that time and she was successfully treated with liposomal amphotericin B. After 6 months, she developed a few hypo-pigmented papules on her forehead. A granulomatous inflammatory infiltrate throughout the dermis was observed at histopathological examination of the skin biopsy. It consisted of epithelioid histiocytes, lymphocytes and plasma cells with the presence of amastigotes of Leishmania in macrophages (Leishman's bodies). The diagnosis of post-kala-azar dermal leishmaniasis was established because at this time there was no hepatosplenomegaly and the bone marrow did not show Leishmania parasites thus excluding VL. About 2 years after the treatment of PKDL with liposomal amphotericin B the patient is still without PKDL lesions.
  
  
  CONCLUSIONS
  Post-kala-azar dermal leishmaniasis is a rare dermal complication of VL that mimics leprosy and should be considered particularly in countries where both diseases are endemic. A co-infection must be seriously considered, especially in patients who are non-responsive to treatment or develop persistent leprosy reactions as those encountered in the patient reported here.
authors.affiliation: Laboratório de Investigação Médica (LIM-56), Imunodermatologia, Hospital das Clínicas da Universidade de São Paulo, Dr Enéas Carvalho Aguiar 470, 3 andar, prédio 2 Instituto de Medicina Tropical, São Paulo, 05403900, Brazil. angelatrindade@uol.com.br.|Departamento de Dermatologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. angelatrindade@uol.com.br.|, Rua Cristiano Viana 450, 163, Jardim Paulista, São Paulo, SP, CEP: 05411 000, Brazil. angelatrindade@uol.com.br.|Posgraduação Instituto de Saúde, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil. angelatrindade@uol.com.br.
authors.forename: Maria Angela Bianconcini
authors.initials: MA
authors.lastname: Trindade
authors.affiliation: Departamento de Dermatologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. lana_luiza@hotmail.com.
authors.forename: Lana Luiza da Cruz
authors.initials: LL
authors.lastname: Silva
authors.affiliation: Laboratorio de Parasitologia, Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil. lmabraz@usp.br.
authors.forename: Lucia Maria Almeida
authors.initials: LM
authors.lastname: Braz
authors.affiliation: Departamento de Doenças Infecciosas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. valdiramato@usp.br.
authors.forename: Valdir Sabbaga
authors.initials: VS
authors.lastname: Amato
authors.affiliation: Stichting Global Dermatology, Munnekeburen, The Netherlands. benaafs@dds.nl.
authors.forename: Bernard
authors.initials: B
authors.lastname: Naafs
authors.affiliation: Departamento de Patologia e Dermatologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. mnsotto@usp.br.
authors.forename: Mirian Nacagami
authors.initials: MN
authors.lastname: Sotto
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001938:Brazil; D060085:Coinfection / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000469:parasitology; D005260:Female; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D007918:Leprosy / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008264:Macrophages / Q000469:parasitology / Q000473:pathology; D008875:Middle Aged; D012867:Skin / Q000469:parasitology / Q000473:pathology
chemical_list: D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B