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Mapping Biopsy Procedure on Management of Severe Buruli Ulcer Due to Mycobacterium ulcerans, Subspecies shinshuense

Toshifumi Takahashi, MD1; Noriki Fujimoto, MD, PhD1; Gen Nakanishi, MD, PhD1; Norihisa Ishii, MD, PhD2; Toshihiro Tanaka, MD, PhD1
[+] Author Affiliations
1Department of Dermatology, Shiga University of Medical Science, Shiga, Japan
2Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
JAMA Dermatol. 2014;150(6):669-671. doi:10.1001/jamadermatol.2013.7497.
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Article InformationCorresponding Author: Noriki Fujimoto, MD, PhD, Department of Dermatology, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga 520-2192, Japan (noriki@belle.shiga-med.ac.jp).

Published Online: April 9, 2014. doi:10.1001/jamadermatol.2013.7497.

Conflict of Interest Disclosures: None reported.

Additional Contributions: The authors would like to thank Kazue Nakanaga, PhD, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan, for her help in detecting the mycobacterium, and Narihito Kodama, MD, Department of Orthopedic Surgery, Shiga University of Medical Science, Shiga, Japan, for his help in surgical treatment.

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Figure.
Clinical, Pathologic, and Polymerase Chain Reaction Findings

A, Clinical presentation just before first debridement: diffuse erythema and swelling on the dorsum of the left hand and necrotic skin ulcer on the lateral edge of the hand were observed; biopsies were performed at sites from 1 through 6 around the ulcer. B, Clinical presentation before second debridement: biopsies from the erythematous lesions were performed at sites 7 and 8. C, Clinical presentation before second debridement; biopsies from the erythematous lesions were performed at sites 9 and 10. D, Clinical presentation before second debridement: biopsies from the erythematous lesions were performed at sites 11 through 13. E, Histological findings from site 8: significant necrosis without granulomatous reaction was observed (hematoxylin-eosin, original magnification ×100). F, Histologic findings from site 10 showed granulomatous reactions without necrosis (hematoxylin-eosin, original magnification ×100). G, Results of polymerase chain reaction (PCR) analysis for IS2404 using pu4f and pu7r primers. Samples 1, 2, 4, 5, 6, and 11 tested positive for IS2404. Gene markers 1 through 13 represent biopsy samples taken from sites 1 through 13, respectively; gene marker N, normal control; gene marker D, 100-bp DNA marker.

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