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).
|Elise Venable, M.B.B.S.
Resident, Anatomic and Clinical Pathology
|Bobbi Pritt, M.D.
Consultant, Clinical Microbiology
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine