Alopecia, arthritis, phot...

When a woman in her 30s with no medical or family history arrived with alopecia, arthritis, photosensitivity, malar rash, and diffuse maculopapular skin rash on her upper and lower extremities, she was diagnosed with systemic lupus erythematosus (SLE) three months ago. She also experienced reduced sensation in all her limbs and generalised erythematous nodular skin lesions on her trunk and extremities (figure 1). Skin lesions with nodules were not typical of SLE or got worse with immunosuppressive treatment. After a skin sample, pathology found foamy histiocytes had diffusely infiltrated the dermis, and the Ziehl-Neelsen stain had shown that macrophages contained acid-fast bacilli (figure 2)