Post-kala-azar dermal leishmaniasis (PKDL) typically occurs after treatment of visceral leishmaniasis. Which of the following best describes the timeline and morphology of Indian PKDL (caused by L. donovani)?

• A Occurs during active kala-azar treatment; presents with vesicular lesions
• B Occurs exclusively in immunocompromised patients; presents as ulcers
• C Follows African VL treatment; appears within 1 month
• D Appears 6 months to 3 years after kala-azar treatment; initially macular hypopigmented lesions progressing to papules and nodules on the face ✓

Explanation

Indian PKDL (caused by L. donovani) typically develops 6 months to 3 years after apparently successful treatment of visceral leishmaniasis (kala-azar). It presents with hypopigmented macules on the face, trunk, and extremities, which progress to erythematous papules and nodules, particularly over the face (malar distribution, nose, chin). These patients serve as human reservoirs for ongoing L. donovani transmission. Sudanese PKDL (also L. donovani) appears earlier (within weeks of treatment) and resolves spontaneously more often.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.