A 47-year-old Malaysian aboriginal woman presented to our clinic with stiffness in her fingers and feet that had been bothering her for about 10 years. The patient had multiple facial deformities, including perioral fibrosis, which gave her face a bird-like appearance; micrognathia (which affected the alignment of her teeth); a narrow mouth with pursed, puckered lips; bound-down skin of the nose; and a loss of wrinkling.
Ivory-colored plaques of hard, thickened skin caused a pigmented, “salt and pepper” appearance on our patient’s face. She also had deformities of all of her fingers and toes that severely restricted her ability to move them (FIGURE).
Our patient lived in an aboriginal village with her mother. She had no history of trauma and no one in her family had a similar disease. Ten years ago, she had an episode of fever with joint pain and was hospitalized for 2 months. Her mother claimed that before that, she had been well and worked outside, gathering latex from rubber trees, but had to stop working due to her disability.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
