Orange-red plaques in an older patient

A 91 year old white woman presented with a four month history of an asymmetrical non-itchy eruption on her face, forearms, and hands. She was otherwise well. She had no history of cough, fever, night sweats, or weight loss. Her medical history included hypertension for which she took ramipril and she had no history of tuberculosis (TB). On examination, there were scattered violaceous papules and plaques over her forearms, orange-red plaques over the left side of her temple (fig 1) and over an old surgery scar site on the bridge of her nose and an old site of trauma on the right forearm. There was no palpable lymphadenopathy or organomegaly.

Dermoscopy of the lesions showed yellow-brown homogeneous patches.

The quantiFERON gold test and ACE level were normal. However, multiple miliary opacities on chest radiography raised the suspicion of TB (fig 2), so an urgent respiratory opinion was sought.

Bronchial lavage for cytology and microbiology were negative for malignancy and TB, respectively.

A skin biopsy showed basal cell degeneration and an inflammatory infiltrate …