title: Cutaneous ulcers in a returning traveller: a rare case of imported diphtheria in the UK.
abstract: We describe a case of cutaneous diphtheria in the UK, presenting as lower leg ulcers in a returning traveller, and discuss the epidemiology, significance and public health implications of this disease and the therapeutic options available. A 65-year-old woman presented with a 6-week history of multiple ulcers appearing on her legs following a holiday in Kenya. Culture of biopsy tissue grew Corynebacterium diphtheriae. A cascade of therapeutic and public health interventions followed, many of which were terminated once the isolate was confirmed as nontoxigenic. Cutaneous diphtheria is a rare, notifiable disease in the UK, but is common in tropical countries, and is most often seen in the West as a traveller's disease. Corynebacteria are common skin commensals, and without appropriate clinical details, laboratories may not recognize C. diphtheriae/Corynebacterium ulcerans. This is likely to have led to under-reporting and under-recognition of the condition.
authors.affiliation: Department of Dermatology, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Portsmouth, UK.
authors.forename: T G
authors.initials: TG
authors.lastname: Nelson
authors.affiliation: Department of Dermatology, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Portsmouth, UK.
authors.forename: C D
authors.initials: CD
authors.lastname: Mitchell
authors.affiliation: Department of Dermatology, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Portsmouth, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Sega-Hall
authors.affiliation: Department of Medical Microbiology and Infection, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Portsmouth, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Porter
mesh_terms: D000368:Aged; D004165:Diphtheria / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000382:microbiology*; D017192:Skin Diseases, Bacterial / Q000382:microbiology*; D014195:Travel