Correspondence

Medical Mystery: Painless Ulcers — The Answer

N Engl J Med 2004; 350:2313-2314May 27, 2004

Article

To the Editor:

The medical mystery in the April 1 issue1 involved a 23-year-old Peace Corps volunteer in Gambia. Painless ulcers developed on his lower legs (Figure 1AFigure 1Leishmania in a Peace Corps Volunteer.) and did not respond to local or systemic antimicrobial therapy.

A slit-skin smear from the margin of the ulcer showed leishmania amastigotes (Figure 1B). Given the patient's geographic exposure, these parasites were Leishmania major. The main animal reservoirs for the protozoan in this geographic area are burrowing rodents, and the vector is the phlebotomus sandfly (Figure 1C). The lesions remain localized and usually heal spontaneously within one year, with scarring, although pentavalent antimonial compounds may accelerate recovery. The differential diagnosis includes tropical ulcer, usually painful and rapidly responsive to β-lactam therapy, and Buruli ulcer, caused by Mycobacterium ulcerans. Buruli ulcers initially spread subcutaneously and therefore characteristically have undermined borders.

Stephen Morris-Jones, M.R.C.P.
Martin Weber, M.D.
Medical Research Council Laboratories, Fajara, Gambia

1 References

1. 1

   Morris-Jones S, Weber M. A medical mystery -- painless ulcers. N Engl J Med 2004;350:1442-1442
   Full Text | Web of Science

Citing Articles (1)

Citing Articles

1. 1

   Masamichi Goto, Kazue Nakanaga, Thida Aung, Tomofumi Hamada, Norishige Yamada, Mitsuharu Nomoto, Shinichi Kitajima, Norihisa Ishii, Suguru Yonezawa, Hajime Saito. (2006) Nerve Damage in Mycobacterium ulcerans-Infected Mice. The American Journal of Pathology 168:3, 805-811
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