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Figure 1. Two years after emigrating from Pakistan to the United States, a 28-year-old man began to have a progressive erythematous eruption, which appeared on his right medial thigh and gradually spread to his trunk and arms (Panel A), legs, and face. The lesions were not pruritic or hypoesthetic. He had paresthesias of both feet. On examination, he had decreased sensation in the third and fourth toes of his left foot. He was taking no medications. A skin biopsy demonstrated granulomatous inflammation with numerous histiocytes in the dermis in a neurovascular distribution. Fite's stain (oil-immersion lens, x100) showed numerous mycobacteria in histiocytes as well as focal infection of cutaneous nerves (Panel B). Leprosy (Hansen's disease) of the borderline lepromatous type was diagnosed, and treatment with dapsone, rifampin, and clofazimine was initiated. Eight months later, the patient's neuropathic symptoms had resolved and his rash had faded substantially.
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