Brian Hinds

JAMA Dermatology Clinicopathological Challenge Chronic Progressive Pink-Yellow Papules and Nodules in a Middle-Aged Man A 38-year-old man presented for evaluation of lesions on his elbows for 10 years, hands for 1 year, and knees for a few months. The lesions were progressively increasing in number and size and were occasionally mildly tender with firm pressure. He was unaware of similar lesions or known lipid abnormalities in family members.

Key words borderline lepromatous leprosy Hansen's disease host immunity leprosy Mycobacterium leprae A 72-year-old man presented to our outpatient dermatology clinic in San Diego, California, complaining of a 3-month progressive asymptomatic rash that began appearing on his left leg (Fig 1) and spread to involve his right leg, trunk, face, and upper extremities (Fig 2). History was notable for remote travel to Mexico and the Philippines.

A skin biopsy from the left helix was obtained. Histopathologic examination revealed a vacuolar interface reaction with marked papillary dermal edema and a patchy perijunctional lymphocytic infiltrate. The dermis was free of increased mucin (Figure 1). Immunohistochemical staining for CD56 and Epstein-Barr virus (EBV)–encoded small nuclear RNA chromogenic in situ hybridization were negative.