The Branded Felon

The Branded Felon

A new patient came into the infectious disease clinic to see me. He was a young man in his early thirties. He had been to multiple doctors for a rash. This rash was thought to be an infection and had come on spontaneously. It started on his shoulder and slowly started getting bigger. He had been put on multiple antibiotics, but they made no difference.


Then he developed a similar lesion on his nose, which also started getting bigger. Alarmed, he sought out an Infectious Disease doctor and came in to see me.


I examined him. The areas on both his nose and shoulder were red and angry looking. They looked like an obvious infection, but  he had not responded to antibiotics. The other unusual thing was the lesion appearing on the nose in an area completely separate from his shoulder.


The first thing I did was take a detailed history. He worked as a construction worker. About two weeks prior to developing the first lesion, he had been involved in digging up an old road. He had encountered pieces of rotten wood that had to be cleared. He had also inhaled a lot of dust at that time.


I suspected a possible fungal infection called blastomycosis. This is often found in rotten vegetation. When inhaled, it can cause a pneumonia, but in rare cases it can instead go to the skin. The only way to confirm this and make a diagnosis was a biopsy. I explained this to him.


He was agreeable to this but was concerned about the cost. He did not have any health insurance. I told him that the biopsy was absolutely necessary for a diagnosis and he consented to it.


I proceeded to do a biopsy of his shoulder lesion. As I was doing so, I asked him why had he not tried to get health insurance? He then said - “I used to have health insurance”. He told me further that he had been a computer programmer with a good job. What happened, I asked?


I met a girl online he said. They developed an online relationship. She lived with her parents and decided to run away from home to come and live with him. Her parents called the police and she was quickly traced to his home. She was only fifteen years old.


My patient told me that he had thought she was seventeen. He said that he never got into a physical relationship with the girl. However, when confronted with her angry parents, the girl changed her story and accused him of kidnapping her.


My patient was arrested and was faced with a lengthy trial and the possibility of many years in jail. He agreed to a plea bargain and admitted to inappropriate contact with a minor. He spent a few months in jail and then was released.

Unfortunately, he now had a criminal record and was a convicted felon. Even worse he was considered a sex offender and placed on the sex offender’s registry. In other words, wherever he moved to, his neighbors would be informed of his conviction. I guess this was the modern day equivalent of the middle ages custom of permanently branding a person for his crime.


He lost his job and consequently his health insurance. The only work he could find was as a construction worker digging up old roads. Nobody wanted to hire a person with his kind of record.


I finished up his biopsy and started him on anti-fungal medications. His biopsy confirmed the diagnosis of blastomycosis, and he responded to treatment. Three months later, his lesions were almost completely resolved. I have not seen him since.


I hope he is doing well today.

Blastomycosis lesion on the back.