Visibly enlarged peripheral nerves in lepromatous leprosy

A 52-year-old man from the Peruvian jungle presented with a 4-year history of progressive distal numbness and facial swelling. He had diffusely infiltrated skin on his face, torso, and extremities (figure, A and B), with patchy pinprick sensation loss. Multiple peripheral nerves were palpable, including ulnar and fibular nerves, in addition to visibly enlarged great auricular (figure, C) and superficial radial nerves (figure, D).