Log in with your email address username.

×

Important notice

doctorportal Learning is on the move as we will be launching a new website very shortly. If you would like to sign up to dp Learning now to register for CPD learning or to use our CPD tracker, please email support@doctorportal.com.au so we can assist you. If you are already signed up to doctorportal Learning, your login will work in the new site so you can continue to enrol for learning, complete an online module, or access your CPD tracker report.

To access and/or sign up for other resources such as Jobs Board, Bookshop or InSight+, please go to www.mja.com.au, or click the relevant menu item and you will be redirected.

All other doctorportal services, such as Find A Doctor, are no longer available.

Steroids control paradoxical worsening of Mycobacterium ulcerans infection following initiation of antibiotic therapy

- Featured Image

Clinical record

A 19-year-old man with a 3-month history of a non-healing ulcer of the right knee and indurated oedema involving the entire lower leg (Box 1) presented after not responding to multiple courses of antibiotics. A punch biopsy showed necrosis of the dermis and subcutaneous tissues, and extensive infiltration with extracellular acid-fast bacilli on auramine–rhodamine staining. Polymerase chain reaction (PCR) testing for the IS2404 insertion sequence of Mycobacterium ulcerans was positive,1 and M. ulcerans was isolated from culture at 6 weeks. The patient reported holidaying on the Bellarine Peninsula, an endemic area for M. ulcerans, 6 months before the development of the lesion. Surgical intervention was deferred due to the extensive area involved and World Health Organization guidelines suggesting antibiotics as first-line treatment for extensive oedematous disease.2

He commenced oral daily rifampicin (600 mg) and moxifloxacin (400 mg) and, within a week, noted a marked decrease in exudate and improvement in the painful oedematous disease of…

email