A 77-year-old man with psoriatic arthritis, on methotrexate, presented with asymptomatic skin lesions. He denied altered sensation within the lesions and history of international travel, but he reported previously cleaning out suspected armadillo burrows. Physical examination revealed pink, smooth, annular, and cyclic papules and plaques on the extremities and back (Figures 1 and 2). Histopathology showed clusters of acid-fast staining organisms within foamy histiocytes in the dermis (Supplemental Figure, available online at http://www.mayoclinicproceedings.org ).
A 77-year-old man with psoriatic arthritis, on methotrexate, presented with asymptomatic skin lesions. He denied altered sensation within the lesions and history of international travel, but he reported previously cleaning out suspected armadillo burrows. Physical examination revealed pink, smooth, annular, and cyclic papules and plaques on the extremities and back (Figures 1 and 2). Histopathology showed clusters of acid-fast staining organisms within foamy histiocytes in the dermis (Supplemental Figure, available online at http://www.mayoclinicproceedings.org ).