The patient was a 22 year old male student who presented with ulcerated, raised lesions on his neck, back and foot. The lesions began as raised red areas that spontaneously drained, ulcerated, healed and then began to grow again. On presentation, the neck lesion had a raised, erythematous border with an ulcerative crater in the center. His history was significant for travel in the middle east the previous summer. He worked on an Israeli irrigation project in June and July and spent a week in the Sinai Peninsula in August, followed by several weeks along the nile in Egypt. during his travel in Israel and Egypt, he experienced bites from multiple flying insects. While in Egypt, he suffered 8 days of watery diarrhea and a 20 pound weight loss and first noticed the neck lesion. This occurred 5 months prior to presentation. At presentation, he had a normal complete blood count including eosinophil count. the infecting organism, a long, slender form with a free flagellum was detected by direct examination and culture of the neck lesion.