# Atypical Mycobacterium ulcerans Infection with Skip Lesions in a 68-Year-Old Male: A Rare Case and Comprehensive Literature Review

## TL;DR

This paper reports a rare case of Buruli ulcer with skip lesions and emphasizes the importance of early diagnosis and combined treatment for better outcomes.

## Contribution

The paper presents a rare case of skip lesions in Buruli ulcer and provides a comprehensive literature review on similar cases.

## Key findings

- Most cases with skip lesions had successful outcomes using combined antibiotic and surgical treatments.
- The reported case initially failed with surgery alone but improved with combined therapy.
- Early diagnosis and multidisciplinary treatment are critical for managing skip lesions.

## Abstract

Background/Objectives: Mycobacterium ulcerans causes Buruli ulcers, typically manifesting as a single progressive necrotizing skin lesion. Rarely, non-contiguous “skip lesions” occur, complicating diagnosis and management. This report describes an atypical case and reviews similar presentations to emphasize early recognition and combined therapeutic strategies. Methods: A systematic literature review was performed using PubMed, Embase, Cochrane Library, Google Scholar, and Scopus databases until December 2024, focusing on cases involving skip lesions. Additionally, a detailed clinical case of a 68-year-old male from Mornington Peninsula, Australia, presenting skip lesions from the distal leg to the proximal knee was documented, including diagnostic PCR testing, surgical interventions, and antibiotic treatments. Results: Twelve studies were identified, totaling 1828 cases with 1179 exhibiting skip lesions. The majority achieved successful outcomes through combined antibiotic (rifampicin and clarithromycin) and surgical management. The reported case initially underwent surgical excision without antibiotics, leading to recurrence. Subsequent comprehensive management combining additional surgical debridement and adjusted antibiotics successfully resolved the infection. Conclusions: Although rare, skip lesions significantly complicate the clinical management of Buruli ulcers. Early diagnosis and a multidisciplinary approach integrating surgical debridement and antibiotic therapy are critical for optimal outcomes and minimizing recurrence risks.