Seen from a frontal perspective, this patient had contracted a nocardiosis infection of his right upper arm due to Gram-positive Nocardia brasiliensis bacteria, which had manifested into a cellulitic inflammation known as an actinomycotic mycetoma. See PHIL 14740 and 14742 for lateral and posterior views, and 19089, for closer view from this angle as well.
Overall, 80% of nocardiosis cases present as invasive pulmonary infection, disseminated infection, or brain abscess; 20% present as cellulitis. Pulmonary infection commonly presents with fever, cough, or chest pain. Central nervous system (CNS) symptoms include headache, lethargy, confusion, seizures, or sudden onset of neurologic deficit.