RESUMEN
BACKGROUND: Post-kala-azar dermal leishmaniasis follows an attack of visceral leishmaniasis and is caused by the same organism, i.e. Leishmania donovani. METHODS: In the present study, biopsy specimens from hypopigmented macules, nodules or plaques of 25 patients clinically diagnosed as PKDL were evaluated for epidermal and dermal changes and for the presence or absence of Leishmania donovani bodies (LDBs). RESULTS: The hypopigmented macules showed a patchy perivascular and periappendageal infiltrate with no demonstrable LDBs in any of the biopsies. In the nodular and plaque lesions, the infiltrate was diffuse, beneath an atrophic epidermis (74%) and follicular plugging (95.6%) was seen in most biopsies. The infiltrate consisted of lymphocytes, histiocytes and plasma cells in decreasing order of presence. LDBs could be demonstrated in only 10 (43.5%) biopsy specimens from nodular and plaque lesions and were never numerous. CONCLUSIONS: Histopathological features of PKDL are elucidated and discussed.
Asunto(s)
Leishmania donovani/aislamiento & purificación , Leishmaniasis Visceral/patología , Adolescente , Adulto , Animales , Biopsia con Aguja , Niño , Estudios de Cohortes , Femenino , Humanos , Inmunohistoquímica , India , Leishmaniasis Visceral/complicaciones , Leishmaniasis Visceral/etiología , Masculino , Persona de Mediana Edad , Pronóstico , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
Kala-azar was revealed by skin lesions in a patient treated for recurrent Hodgkin's disease. These lesions, extremely discreet, consisted of papules on the forehead and in the peribuccal area. Histological examinations initially showed nodular infiltration of the dermis with very few Leishman-Donovan bodies; subsequently, foamy, Virchow-type histiocytes appeared, and Leishman-Donovan bodies became numerous. This clinical and histological similarity with leprosy has already been noted for post-kala-azar dermal leishmaniasis which is frequent in India and in Ethiopia. Skin lesions in kala-azar appear to be exceptional since they were not observed in the 7 cases of kala-azar in immunodepressed patients previously published. The fact that they are discreet may account for their apparent rareness. Easily accessible, they make it possible to diagnose visceral leishmaniasis--an often difficult diagnosis in these patients owing to the underlying disease. Immunodepression has little influence on the clinical and biological manifestations of kala-azar, but reserves must be made concerning the usual criteria for cure.