A 33-year-old African male presented with a series of lesions on the inside of his left leg. It started as a small papule

A 33-year-old African male presented with a series of lesions on the inside of his left leg. It started as a small papule on his calf which grew slowly. Every few weeks a nodule would appear further up the leg and begin to ulcerate. He was diagnosed with type II diabetes mellitus a year ago. He was employed as a security guard and had no history of working in mines or on farms. He is an avid fisherman and often ‘bushwhacks’ to reach his favorite fishing holes. On clinical examination he was found to be obese, weighing 230 pounds. Breathing, blood pressure, and heart rate were normal. His chest x-ray was normal. A full blood count, urea, electrolytes, and liver function tests were normal. The patient declined to be tested for HIV. He had 15 painless lesions extending along his left leg. Further up on his leg he had a small, tender nodule and several lymph nodes on the same leg were swollen and tender. What is your presumptive diagnosis for this case? What is the causative agent? What symptoms lead you to this presumptive diagnosis? Should this patient be encouraged to be tested for HIV? Why? What treatment would