Lightly Pigmented Facial Papules of Variable Size

REPORT OF A CASE A 21-year-old man was admitted to the medical intensive care unit with the diagnosis of meningitis and seizures. On close inspection, lightly pigmented centrofacial papules of variable size were seen ( Figure 1 ). Hypopigmented patches and numerous small spots were present in a confettilike pattern on the patient's left thigh ( Figure 2 ). The results of the ophthalmologic examination were normal. A computed tomographic scan of the patient's head showed multiple periventricular calcifications, findings consistent with periventricular hamartomata. The computed tomographic scan and a magnetic resonance imaging scan of the head also showed a 2-cm enhancing mass in the septum pellucidum region that was thought to represent a large hamartoma or a subependymal giant cell astrocytoma. Multiple echogenic masses thought to represent angiomyolipomas were seen in both kidneys on ultrasound. A skin biopsy specimen from a facial lesion was obtained for routine histopathologic studies (Figure 3). What