The patient suffered a motorcycle injury 2 months prior to contacting the ArogyaUDHC social worker Mr Kar in Mathabhanga. The motorcycle handle penetrated his skin above the right knee. Initially, his local doctor sutured the area and gave antibiotics, but later the patient developed a high-grade intermittent fever with chills and a reddish patchy and nodular inflammatory lesion which he photographed and emailed to us.

After his arrival at PCMS, Bhopal on 6th November, 2012 he underwent incision and drainage of an identified pus point. The pus culture was sterile for bacteria although it showed filamentous organisms on a wet mount (Figure 3). A fungal culture couldn't  be done due to logistic reasons. :-(

He continued to have low grade fever but went home on oral antifungals (tablet itraconazole 200mg twice a day for three months). His temperature charting (attached figure 4) sent to us after he went home showed continued low grade fever spikes but eventually subsided after a few days.

He remained largely well till date (23rd March 2013) but for recent occasions when he experienced some discomfort in the same region (skin of right knee) with even some pus discharge from another new opening. He arrived back at PCMS, Bhopal on 21st March 2013. Has been planned for more extensive debridement on the 25th of March 2013.

Figure 5 shows the debrided tissue that on histopatholigical examination looked normal. However post operative he continues to ooze pus and secretions from the wound. Attached is an image of the wound on April 24 2013 (Figure 6).

He was last (1st part of May 2013)  reviewed by a plastic surgeon in North Bengal Medical College, Dr Parthasarathi Ghosh who advised further conservative management.