Mr. T.J. is a 42-year-old machine press operator. A few days earlier, the tips of his right fingers were caught in machinery and surprisingly, caused little pain. He initially attributed the decreased sensitivity to the cold working place, but subsequently recalled a few other instances of hypoesthesia in warm environments as well. He s quite concerned that he might have diabetes, given a positive family history and his loss of sensory perception. He doesn t recall any problems with sensation in either foot. He also denies increased micturition, unusual appetite or visual changes. Mr. T.J. has a history of mild asthma but is otherwise well. He s not taking any medications.

Mr. T.J. was born in South India and raised in Yemen. He s lived in Canada for 3 years since immigrating here, and returned for a visit to Yemen 2 years ago. He also recently spent a 3-week vacation in the Brazilian Amazon.

On exam, he has superficial lacerations to the 4th and 5th fingertips of his right hand. You note that there are several asymptomatic, hypopigmented plaques 1 on the right arm and 3 on the left leg. He mentions that he had similar lesions a few years ago, just before he emigrated from Yemen. At that time, he was given a dermatology referral but didn t follow up as they healed by themselves. He s unsure of when they recurred and indicates that they re only notable for their scaliness and absence of hair. Closer examination reveals that the plaques are well-circumscribed with elevated margins. Gross motor function is normal but the pinprick test of the affected fingers is not.

Mr. T.J. s blood work shows a random blood glucose level of 6.8 mmol/L. The complete blood count is normal, as are levels of vitamin B¹² and folate. Hand x-rays are unremarkable. What s your diagnosis?