Pre-emptive steroids for a severe oedematous Buruli ulcer lesion: a case report.
BACKGROUND
Severe oedematous forms of Buruli ulcer (BU) often result in extensive tissue destruction, even with the institution of appropriate antibiotic treatment, leading to reconstructive surgery and long-term disability. We report a case of a patient with severe oedematous BU, which describes for the first time the pre-emptive use of prednisolone therapy commenced at the time of antibiotic initiation aimed at limiting the ongoing tissue destruction and its secondary sequelae.


METHODS
A 91-year-old Australian-born Caucasian woman presented with a WHO category 3 oedematous BU lesion on the anterior aspect of her right ankle that she had first noticed three weeks earlier. Treatment was commenced with an antibiotic combination of rifampicin and ciprofloxacin. At the same time, pre-emptive prednisolone was commenced (a dose of 0.5mg/kg daily). Treatment resulted in rapid and significant reduction in the size of the induration associated with the lesion, and no significant increase in the size of the skin ulceration. Antibiotics were continued for 56 days and prednisolone therapy ceased 130 days after antibiotics commenced. No surgery was required. The wound healed completely after 10 months and there was no long-term limitation of movement at the ankle joint.


CONCLUSIONS
Pre-emptive corticosteroid therapy may prevent further progressive tissue necrosis and the need for secondary reconstructive surgery that commonly occurs during the antibiotic treatment of severe odematous forms of BU.
Department of Infectious Diseases, University Hospital, 292-392 Ryrie Street, Geelong, VIC, 3220, Australia. daniel.obrien@amsterdam.msf.org.|Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Melbourne, VIC, 3052, Australia. daniel.obrien@amsterdam.msf.org.|Manson Unit, Médecins Sans Frontières, 67-74 Saffron Street, London, EC1N 8QX, UK. daniel.obrien@amsterdam.msf.org.
Daniel P
DP
O'Brien
Department of Infectious Diseases, University Hospital, 292-392 Ryrie Street, Geelong, VIC, 3220, Australia. SHUFFA@barwonhealth.org.au.
Sarah
S
Huffam
D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D054312:Buruli Ulcer / Q000150:complications / Q000188:drug therapy*; D002939:Ciprofloxacin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004487:Edema / Q000150:complications*; D005260:Female; D006801:Humans; D011239:Prednisolone / Q000627:therapeutic use*; D012293:Rifampin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D002939:Ciprofloxacin; D011239:Prednisolone; D012293:Rifampin