A 35-year-old man from Bihar presents with a chronic painless nodulo-ulcerative lesion on the face that began 2 years ago as a papule. Smear from the ulcer edge shows Leishman-Donovan bodies within macrophages. The lesion is on the nose and has partially destroyed the nasal cartilage. Which species and clinical form does this represent?
- A Leishmania tropica — Cutaneous leishmaniasis (oriental sore)
- B Leishmania braziliensis — Mucocutaneous leishmaniasis
- C Leishmania donovani — Post-kala-azar dermal leishmaniasis ✓
- D Leishmania major — Wet/rural cutaneous leishmaniasis
Correct answer: C. Leishmania donovani — Post-kala-azar dermal leishmaniasis
Explanation
Post-kala-azar dermal leishmaniasis (PKDL) caused by L. donovani presents 6 months to years after treated or untreated visceral leishmaniasis as depigmented macules, papules, nodules, and plaques that may involve the nose/face. However, nasal cartilage destruction and mucocutaneous involvement classically occurs with L. braziliensis (Espundia) in South America. In the Indian context with Bihar geography, PKDL is the correct diagnosis; nodulo-ulcerative facial disease following kala-azar history is pathognomonic for PKDL.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.