title: [Bifocal Buruli ulcer: multiple cephalic lesions after initiation of medical treatment].
abstract: BACKGROUND
  Buruli ulcer (BU) denotes a cutaneous infection by Mycobacterium ulcerans endemic in certain tropical and subtropical regions. Treatment may be either medical and surgical or else purely medical for early lesions. The literature contains reports of several cases of transient aggravation of BU following initiation of medical treatment. We report a case observed in the Ivory Coast, one of the areas with the highest prevalence of BU worldwide. The distinguishing features of our case are the early onset of this paradoxical reaction and the multiple cephalic site of lesions.
  
  
  METHODS
  A 4-year-old child with no prior medical history was referred for two painless ulcerative cutaneous nodules. Incubation of samples from the edges of these lesions revealed the presence of acid-alcohol resistant bacilli (AARB), which were shown by PCR to be M. ulcerans, the causative agent in BU. Treatment consisted of levofloxacin (100mg/d) and rifampicin (150mg/d) for 8weeks. After 7days of medical treatment, seven painless nodules appeared on the patient's scalp. Further PCR for these lesions confirmed the presence of M. ulcerans. The same medical therapy was maintained and after 54days of treatment, all lesions had been healed.
  
  
  CONCLUSIONS
  The originality of this case rests on two features: the bifocal aspect of the lesions, which is uncommon, and the early development of cephalic predominance that occurred after the start of drug treatment. While cases of lesions secondary to initiation of medical therapy have already been described, such lesions generally occurred after at least 2months of treatment and did not involve the head.
authors: Centre de dermatologie, CHU Treichville, 01 BP V3 Abidjan 01, Abidjan, Côte d'Ivoire.
authors: B
authors: B
authors: Vagamon
authors: K-C
authors: KC
authors: Ahogo
authors: B-R
authors: BR
authors: Aka
authors: A
authors: A
authors: Diabaté
authors: Y-I
authors: YI
authors: Kouassi
authors: S-H
authors: SH
authors: Kourouma
authors: C
authors: C
authors: Traoré
authors: I
authors: I
authors: Gue
authors: P
authors: P
authors: Yoboue
authors: J-M
authors: JM
authors: Kanga
authors: A
authors: A
authors: Taieb
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D054312:Buruli Ulcer / Q000188:drug therapy* / Q000382:microbiology; D002675:Child, Preschool; D002680:Chin; D002921:Cicatrix / Q000209:etiology; D007560:Cote d'Ivoire; D004359:Drug Therapy, Combination; D019353:Endemic Diseases; D005148:Facial Dermatoses / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007866:Leg; D064704:Levofloxacin; D019911:Mycobacterium ulcerans / Q000302:isolation & purification; D015242:Ofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use*; D012536:Scalp Dermatoses / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin; D012293:Rifampin