A 16-year-old Sudanese boy was evaluated for generalized pruritus and an eruption on his legs. He complained of episodic decreased visual acuity and eye pain every few months. He denied fever, weight loss, or lethargy, and his medical history was otherwise unremarkable. A skin examination revealed diffuse xerosis and lichenified, asteatotic patches distributed over the knees and pretibia and on the dorsal aspect of the feet (Figure 1). The affected skin was shiny and atrophic in areas. There were also subtle hypopigmented, xerotic patches over the buttocks. The peripheral blood cell count was normal except for 30% eosinophilia (normal, <5.5%). The eye examination (slitlamp and indirect ophthalmoscopy) showed bilateral corneal infiltrates. A 1-cm smooth subcutaneous nodule was palpable at the left iliac crest. An excisional biopsy specimen was obtained from the nodule (Figure 2) and stained with hematoxylin-eosin (Figure 3 and Figure 4).
Leake JAD, Pong AL, Scher CA, Newbury RO, Cunningham BB. Onchocerciasis in a Teenager From Africa—Quiz Case. Arch Dermatol. 2004;140(9):1161-1166. doi:10.1001/archderm.140.9.1161-g