Edematous Mycobacterium ulcerans Infection (Buruli Ulcer) on the Face: A Case Report

Abstract

We report a case of a four-year-old Angolan boy with the edematous form of Buruli ulcer on the face and scalp, who was treated at a rural hospital in the Bas-Congo Province, Democratic Republic of Congo. Treatment consisted of a series of surgical interventions and antimycobacterial chemotherapy (rifampin and ciprofloxacin) for two months. This case demonstrates the diagnostic and management difficulties of an edematous lesion of BU on the face and suggests an enhancement of healing and limitation of extent of excision by specific antibiotherapy. The outcome in this patient also underscores the importance of prompt referral of suspected cases and training of health professionals in the early diagnosis of BU.

Mycobacterium ulcerans Infection (Buruli Ulcer) on the Face: A Comparative Analysis of 13 Clinically Suspected Cases from the Democratic Republic of Congo

“…15 Punch or surgical biopsies from preulcerative forms should be avoided because in our experience biopsies from preulcerative forms became the starting point of extensive ulceration. 10 Laboratory test results were negative for two cases ( Table 2 ). One of these patients had ulcerated lesions on the neck and cheek.…”

“…22 A recent report suggests the possible benefit of specific antibiotherapy to enhance healing and limit the extent of surgical excisions in edematous forms of Buruli ulcer on the face. 10 Preservation of vision is of upmost importance and special attention must be given to minimize the risk of corneal dryness, ulcers, and infection. If the eyelids cannot close fully, the cornea needs to be lubricated with artificial tears and with ointment at night.…”

“…2,[5][6][7][8][9][10] The difficulties encountered in treating such cases and the importance of a conservative surgical approach to their management have been emphasized. 5,[7][8][9][10] The Global Buruli Ulcer Initiative (GBUI) of the World Health Organization has recently recommended the initial use of conservative treatment, particularly when lesions are located on the face, breast, and genitalia. The suggested approach for treatment of such patients is a combination of specific antibiotics, with or without surgery, and to follow an appropriate prevention of disability (POD) program assiduously.…”

“…11,12 Our first experience was with a four-year-old boy in Angola (not included in the present study) who was treated for edematous M. ulcerans infection on the face and drew our attention to the special features and therapeutic requirements of such cases. 10 We report our experience in managing 13 consecutive patients with lesions on the face suspected to be Buruli ulcer at the Institut Médical Evangélique (IME) Hospital in Kimpese, Democratic Republic of Congo, over a five-year period, and compare their clinical presentations and outcomes.…”

Multicenter Study of Buruli Ulcer Disabilities in the Head and Neck Region

“…Agbenorku in 2005 reported BU in the HNR in his study conducted in Ghana [17]. Similarly, Kouame et al in Cote D'Ivoire [18] and Phanzu et al in Angola [19] had also reported BU in the HNR.…”