Case 88

Medical History

A 22-year-old otherwise healthy female patient who is a biology student and lives in a gated community near Belo Horizonte seeks for medical attention. About one month ago, she noticed the appearance of a single hyperemic nodular skin lesion on the anterior side of her right wrist. It has since evolved to the crusted lesion shown in figure 1. She also presents with painful nodules along her right forearm and enlargement of her right supratrochlear lymph nodes. The patient does not report any allergies. She mentions having three cats as well as the habit of gardening.

Based on the clinical history and photograph provided, which is the most likely diagnosis?