A 13-YEAR-OLD boy, the offspring of first cousins, presented with long-standing, brown-black, hyperpigmented, velvety, hyperkeratotic plaques over both ankles, axillae, neck, and groin (Figure 1). His face was acromegaloid and he had a generalized paucity of subcutaneous fat (Figure 2). His muscles were prominent and his abdomen distended (Figure 3). In addition, he was hirsute and his genitalia were enlarged. A paternal uncle has had similar skin lesions since he was a child.
Kulaylat NA, Narchi HH, Baalbaki SA, Tunnessen WW. Picture of the Month. Arch Pediatr Adolesc Med. 1998;152(4):405-406. doi:10.1001/archpedi.152.4.405