A Case of Buruli Ulcer in a Child Requiring Extensive Surgical Excision and Skin Grafting

Abstract

 We report a rare case of a 7-year-old girl with Buruli ulcer. Buruli ulcer is an emerging human disease caused by Mycobacterium ulcerans, which belongs to the non-tuberculous mycobacterial family. M. ulcerans produces mycolactone, which has immunomodulatory effects and causes necrotizing skin diseases. Mycolactone is thought to cause painless lesions and poor inflammatory cellular infiltration. Antibiotics are now recommended as the initial treatment for Buruli ulcers. In Japan, oral rifampicin, levofloxacin (LVFX), and clarithromycin triple therapy is the most common antibacterial treatment. However, LVFX is not covered by medical insurance for children in Japan; therefore, tosufloxacin is used instead for the treatment of children. Surgical treatment is recommended in cases with a delayed diagnosis or advanced cases.