Post-kala-azar dermal leishmaniasis mimicking leprosy relapse: a diagnostic dilemma.

OBJECTIVES: 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.