Surgeons

The reported case in “A case of diffuse Cutaneous Leishmaniasis in a HIV positive patients ” (April, Vol 29 No. 2, 2011, page 106-108) is a rare one. We are happy to be informed about such a case, which is also the first reported case in Bangladesh. After going through this case report, a question has arisen in our mind. Could it be case of post kala-azar dermal leishmaniasis (PKDL)? Not only PKDL is more common in our country, but also 20 % of patients with PKDL have no past history of Kala-azar or its treatment. Only on skin biopsy, LD bodies can be seen in such patients. In those cases DAT and ICT for Kala-azar can help us to identify the subclinical infection. It is seen that DAT can be positive up to 7 years after treatment and ICT using the rK39 can be positive in patient even after 1 year of treatment. Although paucity of LD bodies is more common in PKDL, in nodular variety, plenty of LD bodies can be seen, as demonstrated in this case. By doing ICT and DAT, the case report could have been cleared to us by differentiating from PKDL. However, thanks to all the authors to identify this kind of emerging problem in Bangladesh