13th June 2024

A 41-year-old male presents with skin lesions. He first noticed these 6 months ago

A 41-year-old male presents with skin lesions. He first noticed these 6 months ago. There were small nodules all over his body. They were erythematous and hypopigmented with loss of sensation within the lesions. He was born in India and moved to the UK 5 years ago. There were lesions on his face. His nasal bones were also involved, and he had features of leonine facies. He also had a red injected conjunctiva and reported recent peripheral neuropathy and joint pains. HbA1c, B12, Folate, Syphilis serology, autoimmune panel and chest x-ray were all normal. A biopsy of the skin lesions showed granulomas and gram-positive bacilli. What is the most likely diagnosis?

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