REPORT OF A CASE
A 44-year-old woman was examined at the clinic of the New York College of Podiatric Medicine with a three-day history of pain, pruritus, and swelling localized to the second and fifth digits of her left foot. Three weeks previously, while vacationing in Lima, Peru, she had had similar symptoms, which improved somewhat after therapy with a course of systemic antibiotics. She explained that she had worn open sandals for the majority of her visit to that city and was under the impression that the problem had been caused by an insecticide that was used on the grass in Lima.Physical examination revealed erythema, edema, and tenderness involving the second and fifth digits of the patient's left foot. There were discrete, pinpoint-sized black masses localized to the distal aspect of the affected toes (Figs 1 and 2).Curettage was performed, and the wound debris was sent for