Aggressive multifocal Buruli ulcer with associated osteomyelitis in an HIV-positive patient

Abstract

Mycobacterium ulcerans infection causes a skin disease known as Buruli ulcer (BU), a disorder manifested usually as a solitary and painless nodule or papule that progresses to massive necrotizing destruction and cutaneous ulceration. When healing occurs, it often results in disabling deformities. Buruli ulcer is considered the third most common mycobacterial disease in immunocompetent people, after tuberculosis and leprosy. Although the emergence of Buruli ulcer in Western African countries over the past decade has been dramatic, it has been scarcely reported in industrialized countries. We report a patient from Equatorial Guinea who was human immunodeficiency virus-positive, presenting aggressive and multifocal BU associated with an underlying destructive osteomyelitis, in which only an aggressive surgical approach yielded to a resolution of the disease. In a global world, with increasing migratory population fluxes, an increased awareness of dermatologists regarding the clinical, histopathological and microbiological features of BU is important in order to avoid significant delays in diagnosis and treatment.

Chemotherapy-Associated Changes of Histopathological Features of Mycobacterium ulcerans Lesions in a Buruli Ulcer Mouse Model

“…After completion of treatment, AFB throughout the whole footpad revealed a beaded structure, and cultures went negative, supporting the hypothesis of beading as a marker for loss of viability. Osteomyelitis is a major severe complication occurring in Ͼ10% of all BU patients (31,39). We observed in 15% of all mouse footpads examined bacterial infiltration in the bone marrow (data not shown), but with antibiotic treatment, these bacteria had a beaded appearance, indicating effective treatment.…”

Severe Multifocal Form of Buruli Ulcer after Streptomycin and Rifampin Treatment: Comments on Possible Dissemination Mechanisms

“…The rare published cases of disseminated forms of BU are often associated with bone involvement 1,2,5,8,9 and/or HIV co-infection. 7,8 The first large series of BU with laboratory-confirmed bone involvement focused on 73 cases from 18 months to 45 years of age with a median age of 14.5 years. 2 Thirty out of the 73 selected cases had a multifocal form at admission.…”

“…[4][5][6] The multifocal forms, though rarely described in the literature, have been associated with osteomyelitis and human immunodeficiency virus (HIV) coinfection. 1,2,[5][6][7][8][9] However, the dissemination process behind these forms is not fully understood. Here, we present the case of a young boy who was admitted to the hospital with a bifocal form of BU that disseminated during treatment, generating several new foci.…”

Challenges Associated with Management of Buruli Ulcer/Human Immunodeficiency Virus Coinfection in a Treatment Center in Ghana: A Case Series Study

“…A retrospective study conducted in Cameroon revealed that human immunodeficiency virus (HIV) infection may affect the clinical presentation and severity of BU disease with a reported increased incidence of multiple, larger, and ulcerated BU lesions. [16][17][18] Data available on the absorption of antituberculosis medications in tuberculosis (TB)/HIV coinfection compared with HIV-negative patients showed conflicting results. 19,20 Therefore, whether antimycobacterial combination treatment is less efficacious in persons with HIV infection is unknown and needs to be systematically studied.…”