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Post-kala-azar dermal leishmaniasis — DTM&H MCQ

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HardDermatological tropical conditionsPost-kala-azar dermal leishmaniasisDTM&H

A Sudanese patient develops a diffuse hypopigmented papular eruption one year after apparently successful visceral-leishmaniasis treatment. The diagnosis is uncertain clinically. Which test best confirms post-kala-azar dermal leishmaniasis?

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Correct answer: C — Demonstration of amastigotes in a slit-skin smear or lesion biopsy

The best answer is “Demonstration of amastigotes in a slit-skin smear or lesion biopsy”. The timing, geography and rash suggest PKDL, and parasite demonstration from an active skin lesion provides direct confirmation when clinical diagnosis is uncertain. Fite staining would support leprosy, potassium-hydroxide microscopy could support pityriasis versicolor, and Wood-lamp findings help assess vitiligo. rK39 serology can remain positive after visceral disease and does not demonstrate parasites in the rash. Sampling site and technique matter because parasite density can be low in macular PKDL.

Reference: WHO, Post-kala-azar dermal leishmaniasis manual: https://www.who.int/publications/i/item/9789241505215