Un caso di post Kala-azar dermal leishmaniasis nell'area del mediterraneo

The first case of Post Kala-azar dermal leishmaniasis (PKDT) in a 40-year-old man living in central Italy with no history of foreign travel. He came to us in June '95 with diffuse bright red oval nodules and papules. On his face he had bright red plaques. These lesions appeared one year after a cure for visceral leishmaniasis (VL), caused by Leishmania infantum. Lab. results: Thrombocytopenia (105,000/mm³), polyclonal hypergammaglobulineamia (17.7 g/L), increased ESR, VDRL, TPHA and Lupus band test all neg., speckled ANA 1/80. Decreased in CD4+ T-lymphocyte count 3 not correlated with immunodeficiency and ELISA + Western blot for HIV repeatedly negative suggesting a probable idiopathic CD4+ T-lymphocytopenia. Histology: diffuse infiltrates mostly perivascular lymphocytes, plasma cells and histiocytes, present in the superficial and mid-derma, containing leishmania amastigotes. Parasitology: positive skin culture on Tobie modified Evans medium, bone marrow aspirate neg. but culture showed leishmania development. Parasite characterisation revealed Leishmania infantum. Clinical and laboratory findings indicated PKDL, a disease frequently found in India and Africa, as a dermatological complication of VL, caused by Leishmania donovani. The patient was cured by a high intermittent dose of liposomal amphotericin B (AmBisome).