A 32-year-old Hispanic man presented with a draining plaque on the sole of his right foot. He first noted the lesion 5 years ago as a small pustule, believed to be an insect bite. The affected area gradually extended to involve the plantar and lateral aspects of the foot as papulonodular lesions developed and periodically drained purulent material. The patient was otherwise healthy and denied constitutional symptoms of infection.
Physical examination revealed induration of the right foot, with a draining plaque extending along the ventral and lateral surfaces. Numerous crusts marked healing sites of drainage (Figure 1). Biopsy of the lesion produced purulent exudate and discharge of a firm yellow granule, approximately 2 mm in diameter. The tissue was sent for culture and histologic examination (Figure 2). Radiologic examination showed no bony involvement.