Figure 2: (A) The skin biopsy showed dense lymphohistiocytic infiltrate with multinucleated giant cell involving the entire dermis and epithelioid granulomas without caseous necrosis. (H&E, 40X)(B) Variable-sized empty vacuoles and cysts in the dermis were reminiscent of Swiss cheese pattern. (H&E, 200X) (C) The larger cysts lined by concentric fibrotic stroma, called onion-skin pattern was also noted. (H&E, 100X) (D) Nile red staining demonstrated small lipid droplets in dermis and subcutis. (Nile red staining,200X).