PMC8184239_01
Presence of hypesthetic hypopigmented macules on the right side of the back.
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Hypesthetic hypopigmented macules were found on the right side of the back. (Figure 1) Sensory nerves examination revealed glove and stocking hypesthesia.
(A) Swollen fingers and toes. (B) Radiographic features showed osteolysis and destruction of some phalanges of the hands, bone erosion and destruction of some phalanges of the feet, and destruction and subluxation of some hand joints. (yellow arrow: osteolysis; green arrow: destruction; red arrow: erosion; white arrow: subluxation).
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Fingers and toes were swollen, without redness, warmth, and tenderness on the overlying skin. (Figure 2A) The range of motion was limited in the proximal and distal interphalangeal joints of the fingers. Radiographic features showed osteolysis and destruction of some phalanges of the hands, bone erosion and destruction of some phalanges of the feet, as well as destruction and subluxation of some hand joints (Figure 2B).
Bacilloscopy of smear showing positive bacillus (black arrow).
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A slit-skin smear showed a bacterial index of 4.38+ (Figure 3) and a morphological index of 79%.
(A) Synovial fluid aspiration from the interphalangeal joint of the hand. (B) Acid-fast staining of synovial material from the interphalangeal joint of the hand showed numerous acid-fast bacilli (black arrow).
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We referred the patient to the Department of Orthopedic and Traumatology to perform synovial fluid aspiration from the interphalangeal joint of the hand (Figure 4A). Acid-fast staining of synovial fluid from the interphalangeal joint of the hand revealed numerous acid-fast bacilli (Figure 4B).