Photo Quiz

Prepared by Sidney S.C. Wu, MD, and Daniel I. Kim, MD, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, Calif

A 28-year-old Hispanic man presented to our internal medicine clinic complaining of a reddish rash. It started on his forehead 2 years ago and gradually spread over his face, ears, chest, and back. The rash became more prominent and pruritic, and his hair thinned. In the past year, his feet and lower legs had become increasingly numb. He had been taking hydroxyzine (Atarax, Vistaril) and ibuprofen, which had been prescribed at various community clinics, but these medications did not resolve the rash. His face showed diffuse, flesh-colored nodules, worse at his brow, nose, lips, and ears (Figure 1). His auricles were elongated, and the bridge of his nose was depressed. Cardiovascular, pulmonary, and abdominal examinations were normal. Light-touch sensation was equally diminished in both legs. HIV and syphilis tests were negative. A skin biopsy was performed (Figure 2).

The patient said he had been born and raised in southern Mexico. He moved to the United States 12 years ago and lived primarily in Arizona and southern California. Generally healthy and without any notable medical or surgical history, he lived with family and friends and denied any ill contacts. His family was healthy, and he did not have any pets and had not been exposed to chemicals.

What's Your Diagnosis?

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