The patient is a 70 year old woman with a painful lesion on the side of her foot. She also had a similar lesion on the tip of one of her toes. She had recently returned from Brazil, where she had been for 1 month. The lesions appeared approximately 2.5 weeks into her visit and were preceded by pruritus. She reports walking barefoot on the beaches while in Brazil.
Below are H&E-stained sections of the curetted lesions: