Complicated Mycobacterium ulcerans infection in a child in the Northern Territory

Abstract

A previously well, immunocompetent 8-year-old Aboriginal girl from Darwin presented with a 6-week history of non-healing ulceration 5 cm proximal to the left lateral malleolus, with associated bony tenderness and pain on weight-bearing. She was systemically well, but the ulcer had evolved from a small papule to a 2.5 Â 1.5 cm wound with undermined edges and surrounding erythema (Fig. 1a). Her general practitioner had prescribed a short course of oral trimethoprim-sulfamethoxazole with minimal improvement.She was commenced on empirical intravenous clindamycin and promptly underwent surgical debridement. Pre-operative swab and intra-operative tissue cultures were positive for non-multiresistant methicillin-resistant Staphylococcus aureus (nmMRSA), Pseudomonas aeruginosa, group G Streptococcus and mixed cutaneous and enteric flora; and so ceftazidime was added to clindamycin. Histopathology