4歳児に生じたブルーリ潰瘍

・4歳女児，岩手県で1例目のブルーリ潰瘍で，秋田県と並び最北端発症例である．・リファンピシン，クラリスロマイシン，トスフロキサシンによる3剤併用療法を行ったが改善しないため外科的に切除した．しかし，切除断端に抗酸菌がみられたため追加切除を行った．その際，マッピング生検が有用であった．・ブルーリ潰瘍は，内服治療で効果がない場合に外科的切除が適用となるが，再発や整容面を考慮して切除範囲を検討する必要がある．（「症例のポイント」より）

A case of Buruli ulcer in a child

Sato, Yuri1）Miura, Shinpei1）Watabe, Daisuke1）Endo, Mikiya2）Miyamoto, Yuji3）Ishii, Norihisa4）Amano, Hiroo1） 1）Department of Dermatology, Iwate Medical University School of Medicine 2）Department of Pediatrics, Iwate Medical University School of Medicine 3）Leprosy Research Center, National Institute of Infections Diseases 4）National Sanatorium Tama-Zenshoen

Abstract A 4-year-old healthy Japanese girl presented with a 2 cm-diameter subcutaneous induration on the left upper arm. Cefdinir had been administered, but the lesion had gradually increased in size and become ulcerated. Histopathological examination revealed extensive necrosis in the dermis and subcutaneous tissue. Ziehl-Neelsen staining showed many acid-fast bacilli in the necrotic tissue, and IS2404 was detected by PCR analysis. On the basis of these findings, our diagnosis was that the lesion was a Buruli ulcer. However, it was difficult to determine whether the pathogen responsible was Mycobacterium ulcerans or M. ulcerans subsp. shinshuense. Despite combined therapy with rifampicin, clarithromycin and tofuslixacin for 4 weeks, the lesion did not resolved and therefore surgical resection was performed. However, acid-fast bacteria were found at the excision margin. Additional excision was performed and 4 additional mapping biopsy samples were taken from around the scar. No acid-fast bacteria were isolated from any of the specimens. Currently, 8 months after therapy, no recurrence has been observed. We think that mapping biopsies could be useful when determining the area of resection of a Buruli ulcer.