The patient is a 28-year-old Braziliant immigrant.  He noted 2 year ago a hypopigmented area on his right thigh.  Over the subsequent months it spread to involve most of his right leg.  He then noted similar patches left shoulder.  Nine months age  2008 he developed dime sized painful bmps on his right eye. 

3 months ago he was diagnosed by his primary physician as having a staph infection and treated with a course of antibiotics.  Following his  discontinuation of antibiotics he developed high fever, swelling of his limbs, painful lesions on his leg, as a  result he was hospitalized and underwent 2 excisional biopsies of nodules that appeared in his thigh.  He also has a chronic hepatitis B, as well as positive ANA.  PPD was negative.  Chest plate revealed a stable 3-mm round density in the right hilum. 

He   had anesthesia over the left lateral dorsal foot and the right lateral right thigh.  He also had bilateral cervical neural  enlargement.. 

His grandfather had Hansen's disease.