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Plaques, Papules, and Nodules in a 40-Year-Old Man—Quiz Case

Sophie C. Weatherhead, MBBS, BSc, MRCP; Fraser G. Charlton, MBBS, PhD, MRCPath; Nicholas J. Reynolds, MBBS, MD, FRCP
[+] Author Affiliations

Michael E. Ming, MD

Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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Arch Dermatol. 2006;142(7):921-926. doi:10.1001/archderm.142.7.921-a
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REPORT OF A CASE

A 40-year-old Andean Indian man presented with a 9-month history of crusted plaques on his arm and neck. Over the next month, he developed numerous asymptomatic nodules on his face, trunk, and limbs. His medical history was psoriasis, which had been present for the past 2 years and had not been responsive to treatment with calcipotriene, anthralin, topical coal tar, or phototherapy. He had not had any oral systemic treatment for his psoriasis and had not been using topical steroids. He was not diabetic. Although he had lived in the United Kingdom for 20 years, he visited South America with his family every year; the last occasion had been 2 months after he developed the first crusted plaque. He denied any inoculation injury while abroad. He had no known risk factors for human immunodeficiency virus (HIV) infection, and he had a long-term girlfriend.

Physical examination revealed a healthy-looking man. He had an asymptomatic crusted plaque on his neck (Figure 1) and on his arm, numerous scattered nodules with ulcerated centers on his chest and abdomen (Figure 2), and suprapubic lesions resembling molluscum contagiosum (not shown). A biopsy specimen was obtained from the plaque on his neck (Figure 3 [hematoxylin-eosin]).

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