An unexpected waterborne traveller

Excerpt

A previously healthy 39-year-old male, presented to our outpatients department for the persistence of two cutaneous plaques with a central ulcer in the right hand, one on D4 and the other one above the fifth metacarpophalangeal joints (MCP5). (Fig. 1, panel a) He had been affected by this problem for 8 months and had been already treated with local cryotherapy without resolution. The biopsy was performed in suspect of Mycobacterium marinum infection since the patient reported no travel to endemic areas, but a hand trauma against a fish tank containing tropical fishes at home. Microbiological culture showed the presence of Mycobacterium ulcerans. A treatment course of 8 weeks with rifampin (600 mg/day) and ciprofloxacin (500 mg bid) led to complete resolution of symptoms (Fig. 1, panel b).

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