A 40-year-old African American man presented with a peculiar rash involving the majority of his body. Over the past several months, he had developed night sweats, vision changes, cough, and lower-extremity pain. The rash had progressed over the past 5 years. He denied significant past medical history. His family history was negative for rheumatologic disease or cancers. In the past, he had tried over-the-counter topical corticosteroids for the rash with minimal relief.