A woman in her late 70s with a history of immunoglobulin A monoclonal gammopathy of unknown significance presented with a tender, draining lesion of the central face despite several courses of treatment with antibiotics (Figure, A). The patient lived in Southern California but had visited Kenya for an extended trip a few years prior. Review of systems was negative for fevers, night sweats, weight loss, headache, vision changes, respiratory distress, or arthralgias. On the left nasal dorsum and medial cheek, there was a 3 × 4 cm violaceous plaque with focal purulent drainage. Within several weeks, the lesion rapidly expanded into a vegetative, freely draining plaque covering the cheeks and glabella and approaching the medial canthi (Figure, B). Computed tomography revealed findings consistent with abscess that did not involve the orbits, sinuses, or bone. Chest radiography results were unremarkable. Punch biopsy specimens were obtained for histopathological analysis and tissue cultures (Figure, C). Tissue culture results at 2 weeks remained negative, and a QuantiFERON-TB Gold test result was negative.