Case Presentation A 27-year-old woman from rural Ethiopia presented with a 2-year history of hyperpigmented, lichenified plaques over sun-exposed areas, including the neck, forearms, and dorsal hands. The lesions worsened on sun exposure and were associated with progressive difficulty in swallowing solid food.
There was no history of diarrhea, psychiatric symptoms, or systemic illness. Medical history No chronic comorbidities Diet predominantly maize-based, with little protein or vitamin supplementation Physical examination Hyperpigmented, thickened plaques in a necklace distribution around the neck (“Casal’s necklace”) Hyperpigmentation over the dorsal hands and forearms No neurological deficits No hepatosplenomegaly Laboratory findings Mild anemia (Hb: 10.2 g/dL) Normal electrolytes and liver function tests Clinical suspicion confirmed by dietary history and classic…
