The skin biopsy specimen showed a florid mixed inflammatory cell infiltrate, with numerous foamy macrophages extending from the upper dermis into the subcutaneous fat (Figure 2). At one point, a granulomatous component was present in close apposition to a nerve fiber (Figure 3). Occasional Wade-Fite–positive bacilli were seen in the foamy macrophages (lepra cells). The dermal features were consistent with leprosy of borderline lepromatous type. Focal vasculitic lesions together with numerous neutrophils that are admixed with lepra cells located in adipose tissue typify erythema nodosum leprosum.