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Article in Japanese

A case of cervical skin ulcers by Mycobacterium ulcerans subsp. shinshuense

Junpei HASUMI1), Chie FUKASAWA1), Tadashi HOSHINO1), Hiromichi HAMADA2), Kiyofumi OHKUSU3)

We reported a pediatric case of cervical skin ulcers caused by Mycobacterium ulcerans subsp. shinshuense (M. shinshuense). The patient was a 14-year-old boy with his initial symptoms of high fever, cervical lymph node swelling, and skin rash which lead him to be diagnosed with Kawasaki disease. The diagnosis was then changed several times according to his symptoms and clinical findings to the most possible ones at each moment. Mycobacterial screenings were performed repeatedly but all showed negative. Despite several kinds of treatment, he failed to improve and was transferred to our hospital on his 135th day of the disease. PCR with exudate from his swollen lymph node detected M. shinshuense and the diagnosis was confirmed. A combination therapy of antibiotics (rifampicin, clarithromycin, tosufloxacin) and surgical incision showed a good course. Cases of M. shinshuense infection have increased recently in Japan, but the diagnosis is still difficult because of its rareness. We recommend that PCR should be included in one of the first line diagnostic methods because of its high sensitivity and fast detection time. In order to determine standard management of the disease, more case reports are earnestly required.

1) Division of Infectious Diseases, Chiba Children's Hospital
2) Department of Pediatrics, Tokyo Womens Medical University Yachiyo Medical Center
3) Department of Microbiology, Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine

Key words
Received April 21, 2011
Accepted July 4, 2011

23 (4):383─388,2012