Case presentation A 43-year-old agricultural worker from rural Bolivia presented to a primary care clinic with a gradually enlarging mass affecting the right foot and ankle over approximately two years. The lesion began as a small, painless subcutaneous nodule and slowly progressed to a diffuse deformity marked by multiple confluent nodules and draining sinus tracts. These sinuses intermittently released whitish granular material.
The patient reported no fever, significant pain, pruritus, or systemic symptoms such as weight loss or chronic cough. Medical history No history of diabetes mellitus, immunosuppression, or HIV infection No smoking or alcohol abuse No recent trauma Regular barefoot or inadequately protected exposure to soil and vegetation Physical examination (Figure 1) Diffuse swelling and deformity of the right foot Indurated skin with multiple crateriform sinus openings…
