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November 2018 — Dermatology

The patient is a 59-year-old man with a 12-month history of progressive erythematous and non-pruritic skin rashes (Figure 1) associated with arthralgias, neuropathy, nasal congestion, and loss of eyebrow hair. On physical exam, the patient had demonstrable paresthesias in the distribution of the rash. The patient was born in the United States but had an extensive international travel history, including trips to western Mexico within the past 10 to 15 years. The histopathologic findings are shown in Figure 2 (H&E) and Figure 3 (Fite stain).

Figure 1: Clinical image showing the rash on the patient’s face and neck.
Figure 2: Hematoxylin and eosin-stained skin biopsy (40x original magnification).
Figure 3: Fite stain (400x original magnification).

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Elise Venable, M.B.B.S.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
Bobbi Pritt, M.D.
Consultant, Clinical Microbiology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
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This post was developed by our Education and Technical Publications Team.