Ch-ch-ch-changes

Question: A 57 year old male comes to your clinic with the chief complaint of “I don’t like the way my nose has changed.” He notes that over 3 years his nose has enlarged and now he experiences foul smelling drainage periodically from the tip of his nose. Examination is significant for enlargement of the lower third skin and soft tissue with prominent pores. Intranasally there is no abnormality. What is the most common pathogen associated with this condition?

[Answer will be posted with next week's new question]

Answer to last week's question, "Looks Like a Duck" (March 4, 2019)

D.