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.
Weatherhead SC, Charlton FG, Reynolds NJ. Plaques, Papules, and Nodules in a 40-Year-Old Man—Quiz Case. Arch Dermatol. 2006;142(7):921-926. doi:10.1001/archderm.142.7.921-a