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Buruli ulcer: a systemic disease
Nina Pszolla1, Michael Robindra Sarkar, Wolf Strecker
1Chirurgische Abteilung, Kreiskrankenhaus Blaubeuren, Blaubeuren, Germany.
Summary
This study reports the first documented case of systemic Mycobacterium ulcerans disease spread, leading to multifocal osteomyelitis. Low tissue oxygen may facilitate this hematogenous dissemination, potentially influenced by sickle cell anemia.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Medical Microbiology
Background:
- Mycobacterium ulcerans disease (MUD) typically causes localized cutaneous lesions.
- Systemic spread of M. ulcerans is rare, with limited evidence of bone involvement.
Observation:
- A 4-year-old boy from Angola presented with cutaneous ulcerations and multifocal osteomyelitis.
- Initial treatment included antimycobacterial drugs and hyperbaric oxygenation.
- Despite improvement, new osteomyelitis foci appeared in the femur and humerus.
Findings:
- The case demonstrates systemic M. ulcerans spread with secondary multifocal osteomyelitis.
- Radiological and biopsy findings confirmed extensive bone infection.
- A 99technetium bone scan identified additional osseous lesions.
Implications:
- This case highlights the potential for M. ulcerans to spread hematogenously, causing systemic disease.
- Hypoxia may promote M. ulcerans dissemination, with sickle cell anemia as a potential contributing factor.
- Further research into MUD pathogenesis and systemic involvement is warranted.