A 41-year-old farmer presented to the outpatient infectious disease clinic with a 20-year history of slowly growing lesions on the right leg that had progressed over time to cause gait abnormality.
The lesions initially began as painless, pruritic papules on the knee and gradually spread to the dorsum of the foot. Physical examination revealed palpable, coalescent, subcutaneous nodules with verrucous lesions and associated skin changes.
What is the diagnosis?
