Numerous asymptomatic papulo-nodules and plaques in a young male.

Abstract

A 16‑year‑old boy born of non‑consanguineous marriage presented with numerous solid elevated lesions over his body. To start with, the lesions were asymptomatic flesh‑colored papules over the face 1 year back and gradually, they progressed to attain the present status. Cutaneous examination revealed multiple brown‑colored papules, discrete as well as confluent, yellow to brown‑colored, well‑circumscribed and smooth‑surfaced nodules and plaques of varied sizes over face, more concentrated over the eyelids and chin, ears, neck, axillae, elbows, popliteal fossae, scrotum and oral mucosa [Figures 1‑3]. Hairs, nails and teeth did not reveal any abnormality. There was no history of seizures, dysphagia, dyspnea, hoarseness of voice, blindness, increased urinary frequency, bone pain or any gastrointestinal complaints. Family history was non‑contributory. Systemic examinations including ophthalmologic, oropharyngeal and otorhinolaryngological referral were done and nothing was found to be abnormal. Laboratory investigations including complete blood count, biochemistry panel, lipid profile, thyroid function tests, urinalysis, ECG, chest X‑ray, and ultrasonographic studies of the abdomen were within normal limits. A skin biopsy was done from multiple sites. Histopathological examination in all the specimens showed diffuse proliferation of histiocytes, admixed with Touton giant cells, foam cells, scalloped macrophages, lymphocytes and eosinophils in the dermis [Figures 4‑6]. Immunohistochemical staining for CD1a was found to be negative, whereas CD 68 and factor XIIIa were positive. Question