Buruli ulcer

Synonym(s)

Mycobacterium ulcerans infection

Definition

Chronic, necrotizing disease of the skin due to Mycobacterium ulcerans

Pathogenesis

Inoculation of Mycobacterium ulcerans into the skin occurring via trauma; organism produces mycolactone, an immunosuppres-sive, soluble, polyketide toxin with cyto-toxic properties

Clinical manifestation

Presenting as firm, nontender subcutaneous nodule; within the next 1 to 2 months, area becomes fluctuant and forms a painless, undermined ulceration; lesions with a scalloped border and a sloughing, necrotic base; spontaneous healing after many months

Differential diagnosis

Tropical phagedenic ulcer; cutaneous tuberculosis; deep fungal infection; leishmania-sis; pyoderma gangrenosum; squamous cell carcinoma; vasculitis

Therapy

Surgical therapy: excision of ulcer* Medical therapy: rifampin 600 mg PO per day

References van der Werf TS, van der Graaf WT, Tappero JW, Asiedu K (1999) Mycobacterium ulcerans infection. Lancet 354(9183):1013-1018

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