You are asked to evaluate this 44 year old man with a history of diabetes and housing insecurity who is currently in the emergency room. He is also on metformin. The area is exquisitely tender. What is the best first step in your work-up?

A. Deep punch biopsy (double-punch) to evaluate subcutaneous tissue

B. Bacterial and fungal swab

C. Imaging and surgical consult

D. Oral doxycycline

E. Oral Prednisone

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