Identification of atypical dermal leishmaniasis resolved by restriction fragment length polymorphism
Srija Moulik1, Ritika Sengupta1, Aishwarya Dighal1, Bikash Sardar2, Bibhuti Saha2, Nilay Kanti Das3, Mitali Chatterjee1
1 Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
2 Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
3 Department of Dermatology, Calcutta Medical College, Kolkata, West Bengal, India
Department of Pharmacology, Institute of Postgraduate Medical Education and Research, 244 B, Acharya J C Bose Road, Kolkata - 700 020, West Bengal
Source of Support: None, Conflict of Interest: None
This case report series alerts to the atypical manifestations of dermal leishmaniasis in an area endemic for post kala-azar dermal leishmaniasis, the sequel to visceral leishmaniasis. We have reported two cases with multiple skin lesions, wherein the rK39 strip test, polymerase chain reaction and parasite load confirmed the presence of Leishmania parasites. The causative parasite was identified as Leishmania major by restriction fragment length polymorphism of the ribosomal DNA Internal Transcribed Spacer-1, overruling the clinical suspicion of post kala-azar dermal leishmaniasis. The third case presented with fever and extensive hypopigmented patches in the upper extremities; parasites were identified in blood and skin by polymerase chain reaction and typed by restriction fragment length polymorphism as Leishmania donovani, establishing this as a case of visceral leishmaniasis concomitant with dermal leishmaniasis, secondary to dissemination of viscerotropic L. donovani. The present case series emphasizes the importance of molecular tools to identify the Leishmania species in order to ensure appropriate treatment.