Arpana Rijal

Post-Kala-azar Dermal Leishmaniasis in Nepal: A Retrospective Cohort Study (2000–2010)

Introduction Post-kala-azar dermal leishmaniasis (PKDL) is a cutaneous complication appearing after treatment of visceral leishmaniasis, and PKDL patients are considered infectious to sand flies and may therefore play a role in the transmission of VL. We estimated the risk and risk factors of PKDL in patients with past VL treatment in south-eastern Nepal. Methods Between February and May 2010 we traced all patients who had received VL treatment during 2000–2009 in five high-endemic districts and screened them for PKDL-like skin lesions. Suspected cases were referred to a tertiary care hospital for confirmation by parasitology (slit skin smear (SSS)) and/or histopathology. We calculated the risk of PKDL using Kaplan-Meier survival curves and exact logistic regression for risk factors. Results Out of 680 past-treated VL patients, 37(5.4%) presented active skin lesions suspect of PKDL during the survey. Thirty-three of them underwent dermatological assessment, and 16 (2.4%) were ascertained as probable (2) or confirmed (14) PKDL. Survival analysis showed a 1.4% risk of PKDL within 2 years of VL treatment. All 16 had been previously treated with sodium stibogluconate (SSG) for their VL. In 5, treatment had not been completed (≤21 injections). Skin lesions developed after a median time interval of 23 months [interquartile range (IQR) 16–40]. We found a higher PKDL rate (29.4%) in those inadequately treated compared to those who received a full SSG course (2.0%). In the logistic regression model, unsupervised treatment [odds ratio (OR) = 8.58, 95% CI 1.21–374.77], and inadequate SSG treatment for VL in the past (OR = 11.68, 95% CI 2.71–45.47) were significantly associated with PKDL. Conclusion The occurrence of PKDL after VL treatment in Nepal is low compared to neighboring countries. Supervised and adequate treatment of VL seems essential to reduce the risk of PKDL development and active surveillance for PKDL is needed.

Stevens‐Johnson Syndrome with Idiopathic Thrombocytopenic Purpura Treated with Dexamethasone Pulse Therapy

Stevens‐Johnson syndrome (SJS) is a severe, episodic, acute, mucocutaneous hypersensitivity reaction often caused by drugs. We herewith report a case of SJS with idiopathic thrombocytopenic purpura (ITP) that did not respond to daily oral prednisolone therapy. When treated with dexamethasone pulse therapy, the response was found to be very good. Therefore, we concluded that dexamethasone pulse therapy can be a good and an effective alternative therapy for treatment of such patients. However, to establish its role, further trials in more patients are needed.

Leprosy coinfection with kala‐azar

Leprosy and visceral leishmanias are endemic in Nepal and are both major public health problems. Two patients of visceral leishmaniasis developed leprosy during the course of the disease. Leprosy and visceral leishmaniasis share a similar immunological spectrum and can occur concomitantly in endemic regions.

Outcome of Stevens Johnson syndrome and toxic epidermal necrolysis treated with corticosteroids

Delhi: Century Publication; 2000. 2. Pandey A, Patel R, Uddin MJ. Leprosy control activities in India: integration into general health system. Lepr Rev 2006;77:210-8. 3. Rao VP, Bhuskade RA, Raju MS, Rao PV, Desikan KV. Initial experiences of implementation of functional integration (FI) in LEPRA India projects in Orissa. Lepr Rev 2002;73:167-76. 4. Leprosy Elimination Monitoring in India 2004 in collaboration with International Federation of Anti-Leprosy Associations. 5. National Leprosy Eradication Program. Directorate General of Health Services. Govt. of India. 2008. Available from: http:// www.nlep.nic.in/data.html [last accessed on Jan 9, 2009]

Reticulate Acropigmentation of Dohi: First Case Reports from Nepal

Acropigmentation of Dohi is a rare acropigmentary disorder. We report two cases of reticulate acropigmentation of Dohi from Nepal. To the best of our knowledge, these two cases represent the first case reports from Nepal.