IDCM

What is your diagnosis?
A 71-year-old construction worker presented to the outpatient clinic with worsening nodules on his left hand associated with cutaneous fistulization, accompanied by edema, pain, and limited movement (Figure). He had no fever or other remarkable symptoms. The patient was originally from Guinea-Bissau, which he had last visited five months prior. He usually resided in an urban area with access to potable water but frequently traveled to Guinea-Bissau, where he stayed on a rural farm. He did not recall any insect bites and denied recent contact with animals.
The correct answer will be published in Infectious Diseases and Clinical Microbiology (IDCM), Volume 8, Issue 2.