POST KALA-AZAR DERMAL LEISHMANIASIS WITH ULCERATION ON FOOT: AN ATYPICAL CASE PRESENTATION SUCCESSFULLY TREATED WITH MILTEFOSINE

Visceral Leishmaniasis (VL) or Kala-Azar (KA) is highly endemic in the Indian subcontinent particularly in Bihar. Post Kala-azar Dermal Leishmaniasis (PKDL) is a known reservoir for leishmania parasites for transmission of VL. The kala-azar elimination program was launched by the government of three countries of the Indian subcontinent in the year 2005, which aims to eliminate kala-azar by 2015 and PKDL by 2018. PKDL diagnosis and management has not been addressed properly. In this case report we have described a case of PKDL with ulcer and atypical presentation who was subsequently diagnosed by demonstration of Leishmania donovani bodies in the skin snips through microscopy, kinetoplast-DNA nested PCR and clinically. The patient was treated with miltefosine capsules in the dose of 50 mg twice-a-day for twelve-weeks and responded completely. This case report assumes great importance as prompt diagnosis and treatment of PKDL is essential in the kala-azar elimination program.