A persistent ulcer on the leg

Case presentation

A 42-year-old greenkeeper presents with a large, deep, ulcerated lesion on the medial aspect of his right leg that has been present for six months. He is able to walk without trouble and claims not to be in severe pain. He has no other skin lesions and is otherwise well with normal immunity.

The patient says that he is sure he has acquired ‘a mite under the skin’ in the course of his work, and he has been trying to remove it himself. He cannot be persuaded otherwise by medical staff.