Image 3:
A young man traveled down across the Sahara desert and then east to Ethiopia. On his return to Canada he had a nontender 1 cm healing-furuncle like lesion on the lateral aspect of his calf. He was afebrile The lesion gradually enlarged to 20 cm over 4 months. It was stiff but not painful and there was no fever. Early biopsies revealed no etiology.
Diagnosis:
Buruli ulcer. Mycobacterium ulcerans grew after 2 months in culture. Details in Amer J Trop Med Hyg 61: 689-693; 1999 .