A 53-year-old African American woman presented with a 3-month history of lower back pain, lower extremity weakness, and paresthesias associated with expanding asymptomatic lesions on her face and extremities. She had experienced a dry cough and dyspnea on exertion in the months leading up to her presentation, and had recently moved to the Midwest after having worked in Arizona for the past 5 years.
Clinical examination of her skin revealed scattered 1- to 2-cm verrucous, hyperkeratotic, scaly plaques on her left cheek, left thigh, left hand (Figure 1), and right heel. The results of routine laboratory blood tests and chest radiography were unremarkable. Magnetic resonance imaging of the lower thoracic spine revealed a soft tissue mass involving the vertebral bodies and the paravertebral space, resulting in spinal cord compression. A tissue sample and paraspinal aspirate of the spinal mass were sent for routine culture. A 3-mm punch biopsy specimen was obtained from the facial plaque and sent for hematoxylin-eosin staining (Figure 2 and Figure 3), as well as for bacterial and fungal culture.
Gupta SN, Hille RC. Multiple Hyperkeratotic Plaques and Lower Extremity Weakness—Case. Arch Dermatol. 2004;140(5):609-614. doi:10.1001/archderm.140.5.609-g