case_images: PMC11801015_01
case_images: (A,B) There are multiple erythematous nodules and plaques scattered over the cheeks bilaterally; there is also eyebrow loss (madarosis) extending from the lateral to medial aspect (the images were taken with consent).
case_images: fmed-11-1490279-g001.jpg
case_images: PMC11801015_01_fmed-11-1490279-g001.jpg
case_images: fig1
case_images: Dermatologic examination revealed multiple erythematous nodular lesions with poorly defined borders and infiltrated plaques on the face and hands bilaterally (Figure 1).
case_images: There are hemorrhagic flaccid bullae and vesicles scattered over the medial side of the right leg with the absence of type I Nikolsky sign to emphasize its diagnostic characteristics.
case_images: fmed-11-1490279-g002.jpg
case_images: PMC11801015_01_fmed-11-1490279-g002.jpg
case_images: fig2
case_images: There was also a non-blanching bullous lesion over the right leg with a negative Nikolsky sign (Figure 2).
case_images: Image shows a left forearm with a prominent, inflamed area. The skin in this region is raised and discolored, with a small blister visible at the center. The surrounding skin appears red and swollen, indicating a possible localized infection or irritation.
case_images: fmed-11-1490279-g003.jpg
case_images: PMC11801015_01_fmed-11-1490279-g003.jpg
case_images: fig3
case_images: The left forearm was swollen and tender to touch, with stretched and shiny overlying skin and a central blister indicating localized inflammation (Figure 3).
case_images: There are multiple hypopigmented and erythematous patches and macules on the medial aspect of the left legs.
case_images: fmed-11-1490279-g004.jpg
case_images: PMC11801015_01_fmed-11-1490279-g004.jpg
case_images: fig4
case_images: (A,B) There are bloody crustations overlying a dirty-based ulcer on the left ear pinna and erythematous nodules on the left lateral side of the face. There is also a visible enlarged left great auricular nerve crossing over the left sternocleidomastoid muscle (the arrowhead), and multiple erythematous nodules scattered over the extensor aspect of the right hand and forearm are noted.
case_images: fmed-11-1490279-g005.jpg
case_images: PMC11801015_01_fmed-11-1490279-g005.jpg
case_images: fig5
case_images: (A,B) The figure depicts the histopathological findings from a skin biopsy obtained during the patient's admission. (A) Demonstrates the dermis extensively infiltrated by sheets of foamy histiocytes, characterized by their pale, vacuolated cytoplasm. Notably, well-formed granulomas are absent in this specimen (yellow arrow). (B) Highlights the results of an acid-fast stain, revealing a dense population of acid-fast bacilli packed within the foamy macrophages, a hallmark feature indicative of lepromatous leprosy (depicted with circles).
case_images: fmed-11-1490279-g006.jpg
case_images: PMC11801015_01_fmed-11-1490279-g006.jpg
case_images: fig6
case_images: The skin slit smear was taken for acid-fast bacilli, which turned positive for leprosy (Figures 6A,B).