Histopathological characteristics of post kala-azar dermal leishmaniasis: A series of 88 patients.

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. Limitations: The retrospective nature of the study and the lack of controls were limitations. Conclusion: 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.

Erysipeloid type of leishmaniasis: a clinical study of an unusual presentation of cutaneous leishmaniasis in Iranian women in Isfahan, Iran

Cutaneous leishmaniasis is pervalent in Iran. There are many unusual clinical presentations in acute cutaneous leishmaniasis [ACL]. Patients with infiltrative leisons over the face and nose referring to our department were studied. Fourteen female patients aged 45-74 had this unusual presentation. Direct smear and leishmanin skin test were positive in all of them, and histologically they showed cutaneous leishmaniasis. Other paraclinical data were within normal limits. All the patients responded well to methylglucamine antimonate treatment and their lesion healed leaving no scars. Erysipeloid type of leishmaniasis is an unusual clinical presentation of cutaneous leishmaniasis. The reason why this special presentation is seen only in women is not clear. However, host defense mechanisms, hormonal changes of the body [they were all elderly women], and fragility and friability of the nose and face skin due to senility may be involved