This individual came to a local Lusaka, Zambia health clinic not complaining of symptoms but to bring her granddaughter for a regularly scheduled appointment for antiretroviral human immunodeficiency virus (HIV) therapy. The child’s grandfather was the one who usually accompanied the child to the clinic, and it had been several years since this individual had left her compound to be seen my a health care worker. The lesion first appeared over her left zygomatic arch 4 years ago and slowly and painfully migrated to across her face, involving much of the nasal cartilage. It then enlarged to what can be seen in Figure 1. At the time this picture was taken she was asymptomatic, and on examination she had lost all sensation and significant motor function of the affected areas. The provisional diagnosis was multibacillary leprosy, which encompasses mid-borderline and borderline lepromatous, and lepromatous leprosy. This diagnosis is associated with symmetric skin lesion, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa, as seen in Figure 1. She was subsequently referred to the Leprosy Clinic in Lusaka and empirically treated with monthly doses of rifampin which significantly reduced the lesion and her symptoms as seen in Figure 2. The photograph was taken 5 months after diagnosis and treatment.
Address correspondence to Eiman Zargaran, 633 Bay St., Toronto, Ontario, Canada M5G2G4. E-mail: