The Gorgas Courses in Clinical Tropical Medicine

Selected Cases Seen by 2009 Course Participants

History:  40 yo female with a 3-month history of multiple erythematous, painless plaques initially below the breasts that subsequently spread over the chest, face, back and limbs.  Gradual onset of paresthesias on the left arm and right leg.  No systemic symptoms were present.  3 years earlier similar skin lesions had completely responded to a course of medication, the nature of which was not initially clear at the time of presentation.

Epidemiology:  Housewife born in the Amazon.  No history of TB or sexually transmitted diseases.

Physical Examination:  Afebrile, normal vital signs.  Multiple (more than 100) erythematous plaques on the face, chest, back, abdomen and limbs of 1-3cm in diameter with impairment of sensation in the central clear area of each lesion [Images A-C].  Tendency to central healing in some lesions.  Some hypochromic and desquamative lesions.  Mild loss of motor strength in the ulnar nerves bilaterally, more on the right side.  Rest of PE unremarkable.

Laboratory Examination:  CBC and biochemistry within normal limits.  Normal chest X-ray.

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