Giliane de Souza Trindade, Maria Isabel Maldonado Coelho Guedes, Galileu Barbosa Costa, Poliana de Oliveira Figueiredo, Jônatas Santos Abrahão, Erna Geessien Kroon and Flávio Guimarães da Fonseca
A 31 year-old man, previously healthy Brazilian farm worker presented to the local public health clinic with a five day history of flulike symptoms, such as headache, malaise and myalgia, and with cutaneous lesions distributed on both hands and forearms. The patient also reported high fever and axillary lymphadenopathy on his right side. Peripheral erythema was also observed on the same arm. The lesions were in multiple stages of development ranging from papules to blister-like vesicles, pustules and ulcers. Some lesions had a purulent secretion. The patient reported direct contact with dairy cows (handling and milking), that were presenting with the same kind of ulcerative lesions. The patient received analgesics for the pain and fever and also antibiotics for topical use on the pustular lesions. Although he was not hospitalized, he was unable to work for 5-6 days, when papules and vesicular lesions turned pustules and ulcers. Around 8 days later he returned to the clinic and the pustules and ulcers had started to heal developing into black scars. The patient reported he was feeling better and was able to return to work. What is your diagnosis?