A 35-year-old man with poorly controlled diabetes presents to the emergency room with a 10-day history of chest pain, shortness of breath, and a non-productive cough. He also complains of right ankle pain that has worsened over the past two months. On physical exam, he has decreased breath sounds bilaterally and a verrucous skin lesion on his right anterior thigh. His temperature is 101.7 degrees Fahrenheit. A chest X-ray shows bilateral mass-like lesions. An X-ray of the right ankle shows a destructive lesion in the distal fibula with cortical disruption. An incision and drainage of the right ankle shows purulent drainage around the fibular lesion. A bronchoscopy with biopsy reveals acute inflammation.