Mycobacterium Ulcerans - Clinical Manifestations

Clinical Manifestations

Lesions are usually single and begin as firm, painless, non-tender, movable, subcutaneous nodules 1 to 2 cm in diameter or as small papules. Many patients complain of itching in the lesion. In 1 or 2 months, the nodule may become fluctuant and ulcerates, with an undermined edge that often extends 15 cm or more. The skin adjacent to the lesion, and often that of the entire corresponding limb, may be indurated by edema. Ordinarily, no regional lymphadenopathy or systemic manifestations are noted. There is, however, speculation that massive disseminated lesions may cause systemic toxic effects. Ulcers may remain small and heal without treatment, or may spread rapidly, undermining the skin over large areas, even an entire leg, thigh, or arm. Important structures such as the eye, breast, or genitalia are sometimes severely damaged. Most lesions heal spontaneously but without appropriate therapy frequently leave extensive scarring, with deformity. Osteomyelitis may lead to amputation.