A shave biopsy was performed on the superior left arm (Fig. 18.1), and the medial left leg (Figs. 18.2 and 18.3) and both specimens measured about 0.6 × 0.5 × 0.1 cm. The low magnification showed a psoriasiform epidermal pattern with a chronic inflammatory infiltrate (Fig. 18.4). Sections showed a dense, interstitial infiltrate of lymphocytes and numerous plasma cells at high magnification (Fig. 18.5). An immunostain for spirochetes revealed numerous, short-rod shaped organisms in the lower epidermis and upper dermis (Fig. 18.6). Only at higher magnification, the corkscrew form of the spirochetes were appreciated (Fig. 18.7).