A 26 yr. old man from Bihar comes with juicy looking papules over face and back of neck which were hypopigmented and normo aesthetic with no nerve thickening. History of prolonged fever in childhood was present. Diagnosis?
Ans. B. Post Kala Azar dermal leishmaniasisLeishmaniasis is a disease caused by an intracellular protozoan parasite (genus Leishmania) transmitted by the bite of a sandfly.Classification: Categorization by clinical disease: In this system, leishmaniasis is divided into 3 primary clinical forms:1. Cutaneous (localized, diffuse (disseminated), leishmaniasis recidivans, post-kala-azar dermal leishmaniasis),2. Mucocutaneous,3. Visceral (kala-azar).Cutaneous leishmaniasis includes the following features:a. Localized cutaneous leishmaniasis; Crusted papules or ulcers on exposed skin; lesions may be associated with sporotrichotic spreadb Diffuse (disseminated) cutaneous leishmaniasis: Multiple, widespread nontender, nonulcerating cutaneous papules and nodules; analogous to lepromatous leprosy lesionsc. Leishmaniasis recidivans: Presents as a recurrence of lesions at the site of apparently healed disease years after the original infection, typically on the face and often involving the cheek; manifests as an enlarging papule, plaque, or coalescence of papules that heals with central scarring (i.e, lesions in the center or periphery of an old healed leishmaniasis scar); relentless expansion at the periphery may cause significant facial destruction similar to the lupus vulgaris variant of cutaneous tuberculosisd. Post-kala-azar dermal leishmaniasis; Develops months to years after the patient's recovery from visceral leishmaniasis, with cutaneous lesions ranging from hypopigmented macules to erythematous papules and from nodules to plaques; the lesions may be numerous and persist for decades. Mucocutaneous leishmaniasis consists of the relentless destruction of the oropharynx and nose, resulting in extensive MID facial destruction.Visceral and viscerotropic leishmaniasis include the following features:a Visceral leishmaniasis (kala-azar): Potentially lethal widespread systemic disease characterized by darkening of the skin as well as the pentad of fever, weight loss, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemiab. Viscerotropic leishmaniasis: Nonspecific abdominal tenderness; fever, rigors, fatigue, malaise, nonproductive cough, intermittent diarrhea, headache, arthralgias, myalgias, nausea, adenopathy.Management- Pharmacologic therapies include the following:a. Pentavalent antimony (sodium stibogluconate or meglumine antimonate): Used in cutaneous leishmaniasis.b. Liposomal amphotericin B (AmBisome): Effective against pentavalent antimony-resistant mucocutaneous disease and visceral leishmaniasisc. Oral miltefosine (Impavido): Approved by the FDA in March 2014 for visceral leishmaniasis due to L donovani; cutaneous leishmaniasis due to L braziliensis, L guyanensis, and L panamensis; and mucosal leishmaniasis due to L braziliensisd. Intramuscular pentamidine: Effective against visceral leishmaniasis but associated with persistent diabetes mellitus and disease recurrence.
Tuberculoid leprosy
Post Kala Azar dermal leishmaniasis
Lepromatous leprosy
HIV
Bacterial Infection of Skin