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The presence of acanthosis with a proliferation of bland spindle cells and entrapped hyaline collagen bundles, suggested the diagnosis of dermatofibroma. However, further examination revealed groups of macrophages with abundant blue-gray granular cytoplasm located at the periphery of the lesion. Wade-Fite stain revealed numerous acid-fast bacilli arranged in clumps within histiocytes, confirming the diagnosis of histoid leprosy (HL) (Figs. 1A, B).