Charlie was a 26-year-old drummer from San Francisco. He was a high school music teacher who had just returned from participating in a teacher exchange program in Mali. A week after his return, he developed a reaction to what he thought was an insect bite on this left hand. After a few days, the site became swollen and blistered. Finally, the lesion turned into a dark black ulceration, and it was at this point that Charlie sought out medical attention.