ABSTRACT
A 35-year-old man presented to hospital complaining of a painful skin lesion on his left shoulder. The lesion had initially developed 3 months earlier but had become increasingly tender and inflamed. Green, malodorous fluid was now discharging from the lesion and the pain was not controlled with simple analgesia. In addition to the lesion on his shoulder, he reported similar lesions covering his limbs and trunk, which were painful and occasionally developed signs of infection. His past history was significant for an admission to hospital in Ghana 18 months ago, where he presented with fevers and vomiting and was treated for both malaria and typhoid. Following treatment with aminoglycoside antibiotics, he sustained an acute kidney injury requiring several weeks of haemodialysis and had since developed chronic kidney disease. He subsequently suffered from widespread bone pain, attributed to renal osteodystrophy. He often experienced fevers but denied night sweats or unintentional loss of weight. He took no medications currently and denied recreational or herbal drug use. He did not smoke or drink alcohol. He lived with his cousin and worked as a secretary. He had returned from Ghana 9 months earlier and had not travelled abroad since. He had multiple episodes of unprotected sexual intercourse with one female partner while in Ghana.
