The patient WAS a 47 year old male, born in Brazi, who came to USA 3 years ago.
For more then a year he had recurrent epistaxis and recently developed ulcerating skin lesions. He was evaluated by an outside physician for pancytopenia and underwent a bone marrow biopsy which revealed numerous acid-fast bacilli without granulomas.
Clinical findings included:
- mild edema of the hands
- bilateral lower lateral leg ulcers that are shallow and had no evidence of infection
- large confluent and monomorphous erythematous plaques without central clearingoverlying the face, trunk, bilateral upper and lower extremities
- edematous and pendulous ears
- congested and edematous nose
- edematous hands and bilateral lower leg erosions
- no palpable nerves
- atrophic and sclerotic skin on the distal extremities
A biopsy from an ulcer on the ankle was reviewed.
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