Clinical Introduction

A 22-year-old woman presented to the emergency department with a painless lesion on the thenar eminence of her left hand (figure 1). This originally started as a small wound from a cut 2 weeks prior. Of note, she was working with sheep before the lesion developed. She had no previous medical history, and she was not on any medications. She looked well, apyretic and had normal vital signs. There was evidence of lymphangitis spreading from the wound to the forearm with no palpable lymphadenopathy. …