First reported case of Mycobacterium ulcerans infection in a patient from China

Buruli ulcers have not been previously described in China, and only once at higher latitudes on the northern hemisphere. A patient who travelled in th e Shan Dong Province in the People's Republic of China developed an ulcer w hich was proven to be a Buruli ulcer. The clinical picture and histopatholo gical findings from biopsy specimens are characteristic for a Buruli ulcer, and also the growth in culture (Coletsos medium) at a restricted temperatu re of 30 degrees C. A multiplex polymerase chain reaction (PCR) based on th e amplification of the gene encoding for 16S ribosomal RNA and a nested PCR based on the Mycobacterium ulcerans specific repeated sequence 2404 were p erformed. These PCR investigations identified the bacteria as M. ulcerans, subspecies shinshuense. The patient was initially treated with clarithromyc in and rifampicin, which was changed to ciprofloxacin and rifabutin when ri fampicin resistance of the first isolate was established. There were no sig ns of reactivation of the disease 6 months after the end of treatment. M. u lcerans infection occurs above 30 degrees latitude on the northern hemisphe re in China and is caused by M. ulcerans, subspecies shinshuense. This case appears to be cured by chemotherapy alone, in contrast to the general expe rience that surgical treatment is indicated. The granulomatous reaction wit h only fragments of acid-fast bacteria in the biopsy at the end of treatmen t may indicate the development of an adequate cell-mediated immune response leading to resistance to the infection.