A rare large cutaneous ulcer from the rural area, Democratic Republic of Congo. What is the diagnosis: Buruli ulcer?

Mycobacterium ulcerans disease, commonly called Buruli ulcer (BU), is a neglected and emergent tropical disease. Buruli ulcer is endemic in the rural wetlands of the tropical countries/regions of Africa, The Americas, Asia, and Australia but is uncommon in non-African countries. Infection with M. ulcerans often leads to extensive destruction of skin and soft tissue with the formation of large ulcers. Ulcerative and non-ulcerative forms of the disease exist. The non-ulcerative lesions may be papules, nodules, plaques, edemas or osteomyelitis 2 . The disease often occurs in people who live or work close to rivers and stagnant bodies of water 3 . The disease is more severe in impoverished inhabitants of remote rural areas. Approximately 70% of those affected are children under the age of 15 years. The characteristic skin ulcers have undermined edges and are usually painless.