Borderline Hansen complicated by a metastatic cold abscess

An 18 year old male presented to our dermatology outpatient department complaining of multiple light coloured lesions all over his body for 1 year and a large pear shaped swelling on the right side of his chest for 4 months duration. Initially the patient noticed an asymptomatic, coin sized, light coloured flat lesion on his trunk a year ago and subsequently multiple such lesions appeared on his chest, abdomen, back, thigh and upper limbs which gradually enlarged to their present size. Eight months after the appearance of hypopigmented lesions, a single pea sized swelling appeared on the right side of his chest, which gradually expanded and was associated with mild pain. There was no complaint of fever, productive cough, evening rise of temperature, weight loss or any other constitutional symptoms. The patient also denied any previous history of leprosy or tuberculosis in himself or family members. On examination multiple, well defined, hypo-pigmented macules and plaques were present on his chest, abdomen, back, thigh and upper limbs. These lesions varied in size from the smallest 0·5 cm £ 0·5 cm lesion on his back to the largest of a 5 cm £ 5 cm lesion on his