A previously healthy individual in his 20s presented to the dermatology clinic for evaluation of annular skin lesions that appeared first on his right ankle and then on other areas of his body over a 3-month period. He reported numbness and paresthesia in the areas of affected skin and an inability to fully extend his fingers. The patient did not take any prescription medications or herbal supplements and had immigrated to the US from Samoa 4 years prior. Physical examination revealed multiple tattoos and annular erythematous plaques on his face, chest (Figure, left panel), back, arms, and legs. The patient had bilateral palpable thickened auricular and ulnar nerves, claw-hand deformity (Figure, right panel), foot drop bilaterally, and decreased sensation to temperature over the areas of skin plaque. Results of testing for rapid plasma reagin, antinuclear antibodies, and rheumatoid factor were negative. Examination of punch biopsy samples from 2 plaques on his back revealed granulomatous periadnexal and perivascular dermatitis with diffuse granulomatous infiltrate and foamy histiocytes. Findings on acid-fast bacilli stains and mycobacterial polymerase chain reaction (PCR) testing were negative. Repeat biopsy of a skin plaque revealed no fungal organisms, and Mycobacterium leprae was not identified on Fite Faraco stain.
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Corresponding Author: Saadeddine Saad, MD, Baylor Scott & White Clinic—Temple, 2401 S 31st St, Temple, TX 76504 (firstname.lastname@example.org).
Published Online: June 30, 2023. doi:10.1001/jama.2023.9915
Conflict of Interest Disclosures: None reported.
Additional Information: We thank the patient for providing permission to share his information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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