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PKDL Mucosal L. donovani — SCE Infectious Diseases MCQ

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HardTropical & Imported InfectionsPKDL Mucosal L. donovaniSCE Infectious Diseases

A 40-year-old woman from rural India presents with a chronic non-healing nasal ulcer with tissue destruction. Biopsy shows Leishmania amastigotes within macrophages. Leishmania species PCR identifies L. donovani. She has no visceral disease. What is this unusual presentation?

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Correct answer: E — Post-kala-azar dermal leishmaniasis (PKDL) with mucosal involvement — L. donovani can cause cutaneous/mucosal disease after VL treatment or in the absence of prior VL

While mucocutaneous leishmaniasis is classically associated with L. braziliensis (New World), L. donovani (the agent of VL in the Indian subcontinent) can cause PKDL with mucosal involvement. PKDL presents weeks to years after VL treatment (or sometimes without documented prior VL) with skin lesions ± mucosal involvement. Treatment is Liposomal Amphotericin B or Miltefosine for prolonged courses. PKDL patients serve as a reservoir for Leishmania transmission — treatment has both individual and public health benefit.

Reference: WHO 2022 – Leishmaniasis; NICE CKS 2024