PMC7456484_01
Lesion and/or residual scarring after treatment at different time points. (a) First presentation in 2014 with erythematous plaques with crusting and loss of the left eye. (b) Marked improvement after 28 doses of sodium stibogluconate (SSG) in 2014. (c) In 2017, reappearance of plaques over old healed areas. (d) In 2019, relapsed and diagnosed (and subsequently treated) as post-kala-azar dermal leishmaniasis. (e) In 2019, after treatment with miltefosine.
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fig1
The patient presented with extensive erythematous plaques on forehead, central face, perioral, and cheeks that extended to both ears (Figure 1(a)). Her lesions markedly improved but with residual scarring (Figure 1(b)). She again presented in 2017 with new dermal plaques over old healed lesions (Figure 1(c)). New plaques were seen on the nostrils and chin with marked perioral scarring limiting the mouth movements (Figure 1(d)). Treatment continued with the reduced dosage for further 2 months with clinical improvement (Figure 1(e)) or apparent healing of lesions.
Microscopic image (x1000) of the punch biopsy tissue section stained with hematoxylin and eosin (H&E). Arrow points to Leishman-Donovan parasite bodies.
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fig2
Skin biopsy was done, which showed granulomatous inflammation with predominant infiltration of lymphocytes, a few histiocytes, and LD bodies (Figure 2).