Photoclinic: Multiple nodular lesion and sinus tracts on the planter surface of the right foot.

A 61-year-old woman presented to the Infection Ward of Imam Khomeini Hospital with right foot edema, multiple nodular lesions, and sinus tracts (Figure 1). The lesions were mainly distributed on the plantar surface with some extension onto the dorsal surface. The initial lesion was a single nodule, followed by the appearance of successive nodules in close proximity. This problem began five years prior and progressed gradually. At presentation, she was a febrile and her right foot was rm with nontender swelling. On examination, the right foot showed swelling and induration. The surface of her foot showed multiple nodules with draining sinuses and crusting. The skin was hypo- and hyperpigmented with signs of both old healed and active sinuses. A few granules were present in the active sinuses. X-ray of the foot was normal. The patient, a farmer, was from a northern Iranian village. Her foot had been exposed to contaminated soil.