Overview
Post-kala-azar dermal leishmaniasis (PKDL) is a chronic skin condition that can develop after recovery from visceral leishmaniasis (kala-azar), characterized by skin lesions that may precede, coincide with, or follow the visceral form of the disease 12.Diagnosis
Clinical presentation includes skin lesions, often macular, papular, or nodular, typically appearing months to years after treatment of kala-azar 12.
Laboratory tests may show evidence of past or subclinical visceral leishmaniasis, including anemia and leukopenia 2.
Imaging and histopathology of liver in PKDL patients generally do not reveal portal hypertension or cirrhosis, though biochemical evidence of hepatitis can occur in some cases 1.Management
First-line treatment typically involves antimonials (e.g., sodium stibogluconate) or amphotericin B for refractory cases 12 (specific doses not provided in abstracts).
Adjunctive treatments may include immunomodulatory therapies, though specific recommendations vary 2.Special Populations
No specific data provided in abstracts regarding PKDL in pregnancy, pediatrics, elderly, or patients with comorbidities 12.Key Recommendations
Consider PKDL in the differential diagnosis for patients with a history of kala-azar presenting with chronic skin lesions, especially in endemic regions 12 (Evidence: Moderate).
Biochemical markers of liver function should be monitored, as subclinical hepatitis may occur 1 (Evidence: Weak).
Antimonial compounds remain a cornerstone of treatment for PKDL, with amphotericin B reserved for refractory cases 12 (Evidence: Expert opinion).References
1 Aggarwal P, Wali JP, Chopra P. Liver in kala-azar. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 1990. link
2 Blount ER, Hartmann R, Nernoff J. Kala-azar as a cause of disseminated intravascular coagulation. Clinical pediatrics 1980. link