Ulcerative Infiltrated Plaques in a Bolivian Boy

Case Report A5-year-oldboy fromBoliviawhohadarrived inSpain only 15 days previouslywas referred to our department with a 3-week history of worsening cutaneous lesions. The lesions started with erythema and induration, and gradually progressed to become ulcerative plaques localized on his right leg, lumbar region, right temple, and right eyebrow. All lesions were asymptomatic and the patient was afebrile. Examination of the lumbar region demonstrated a 5 cm erythematous, indurated plaque containing small punched-out ulcers with a yellow base. A similar, smaller lesion was nearby. On the right leg he had a large indurated plaque with extensive ulceration (Fig. 1). Similar plaques on the right temple and right eyebrow had superficial yellow crusting. Examination of the oral cavity revealed black tooth remnants, and two yellow papules on the upper gingiva (Fig. 2). Lymphadenopathy was found in the right groin. Ear, nose, and throat examinations showed no abnormality. Complete blood count, liver function tests, glucose, urea, creatinine, lipoproteins, and protein electrophoresis were within normal range. Chest radiograph was unremarkable. Mantoux skin test, leishmania serology, and cultures from surface swabs formycobacteria and leishmaniawere all negative. Skin biopsy was performed. On the basis of the findings (Fig. 3) further investigations were undertaken.