A 46 year old man presented with a 15 year history of generalized excessive sweating and palpitations. He also had progressive redness of both eyes along with blurred vision. Clinical examination revealed clubbing, soft tissue swelling involving all digits (Fig. 1A) and asymptomatic multiple raised firm skin coloured nodules and coalescing plaques of around 5 × 5 cm over both shins (Fig. 1B). A single depigmented patch suggestive of focal vitiligo was also noted over the neck. Ocular examination revealed conjunctival chemosis (right > left), proptosis and visual acuity of 6/12 of right eye (Fig.