Clinical history:

A 46-year old clerk complained of asymptomatic papular rash at the pubic region, limbs and trunk for the past three months. He found that the number of these papules increased gradually and he had attempted self treatment by trying various topical creams without response. He also had mild malaise and low grade fever recently and he was admitted into hospital for investigation of weight loss and prolonged fever. On examination, there were multiple pearly shining surface papules scattered unevenly at the arms and few on the trunk. He claimed to have good health in the past.