A 7-year-old boy presented with numerous asymptomatic
whitish flat lesions of varying sizes over the whole body
for last two years. Patient was diagnosed as kala-azar about
3 years previously, and was treated suboptimally. There was
no other systemic complaints like fever, pain abdomen or
photosensitivity. On examination, there were asymptomatic
hypopigmented macules and patches over the face (Fig.
1), trunk and extremities (Fig 2). There
was no evidence of any scaling, erythema, itching sensation
or photosensitivity. There were no mucocutanoeus
abnormalities, and lymphandenopathy, hepatosplenomegaly or
any other systemic abnormalities. Slit skin smear from the
lesions demonstrated the Leishmania donorexi;
parasites and ELISA demonstrated the antibody in blood
against the parasites. A diagnosis of post kala-azar dermal
leishmaniasis was made (macular variety).
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Fig. 1 Hypopigmented macules and patches
over face.
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Fig. 2 Hypopigmented
macules and patches over trunk and extremities
(back).
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About 1-2 years after recovery from
kala-azar, post kala-azar dermal leishmaniasis (PKDL)
develops as hypopigmented macules and patches over face and
limbs. It gradually develops into papules, plaques and
nodules. Macular variety of PKDL has the differentials of
pityriasis versicolor (asymptomatic or mildly pruritic scaly
hypopigmented patches over upper back, neck, chest, upper
arms, early vitiligo (hypopigmented patches with scalloped
margin), lepromatous leprosy, post inflammatory
hypopigmentation following pityriasis rosea, lichen
sclerosus et atrophicus, nevus depigmentosus (congenital
hypopigmented nevus), nevus anemicus (hypopigmented patch
because of increased sensitivity to endogenous
catecholamines and subsequent vasoconstriction in that
area). He was treated with amphotericin B injection (1
mg/kg/day) for 3 cycles of 20 days and the lesions started
to heal slowly. Microbiological cure was demonstrated by
polymerase chain reaction (PCR).