A 58-year-old male farmer from the Ancash region in the Peruvian highlands presented to the outpatient clinic with an ulcerated lesion on the left thumb and several nodular lesions on the left forearm. He sustained minor trauma from a wood splinter in his left thumb a month before presentation. Later, the wound ulcerated and started to drain serous fluid (Figure 1A), with the subsequent appearance of multiple small, erythematous, and painless nodules in his left forearm (Figure 1B). Some had undergone spontaneous suppuration with ensuing crusting. Culture of the aspirate from the nodular lesions was positive A 58-year-old male farmer from the Ancash region in the Peruvian highlands presented to the outpatient clinic with an ulcerated lesion on the left thumb and several nodular lesions on the left forearm. He sustained minor trauma from a wood splinter in his left thumb a month before presentation. Later, the wound ulcerated and started to drain serous fluid (Figure 1A), with the subsequent appearance of multiple small, erythematous, and painless nodules in his left forearm (Figure 1B). Some had undergone spontaneous suppuration with ensuing crusting. Culture of the aspirate from the nodular lesions was positive.