Excerpt
It was at the end of December that Alfred first noticed one and then two red bumps under the right side of his chin. He gave them little thought at first. They seemed like pimples from shaving irritation, or maybe ingrown hairs. But the bumps didn't go away. Instead, though painless, they gradually got larger. Their tops broke open to form shallow ulcers, which drained a small amount of yellow fluid.... At the end of January, he became aware of a vague swelling just under the point of his chin, also painless. Over the next week it slowly enlarged to the size and firmness of a hard-boiled egg yolk. The ulcers had also gotten bigger; each was now about a quarter inch across.... On February 1, 2003, Alfred came to the walk-in clinic at my hospital.... He showed the ulcers and the swelling under his chin to a physician on duty.... I was in my office when my beeper went off. The doctor who answered the phone didn't mince words. "I've got a seventy-two-year-old guy down here who was in a jungle in Peru and now has a weird ulcer He says he thinks it might be leishmaniasis." I had never seen a case of leishmaniasis, but I knew that the American form, left untreated, could eat up the middle of a person's face, starting with his nose. The Portuguese in Brazil call the condition
espundia, or sponge, because that's what the patient's face becomes---a ragged, porous hole, like a sea sponge.
"I'll be right down," I said.
Copyright 2004 by Pamela Nagami