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Marjolin's ulcer — DTM&H MCQ

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HardDermatological Tropical ConditionsMarjolin's ulcerDTM&H

A farmer in Ghana has a slowly enlarging painless leg ulcer with undermined edges. Mycobacterium ulcerans PCR is positive and bone is not involved. Which disease-specific treatment should be started alongside wound and disability care?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Rifampicin plus clarithromycin for 8 weeks

The best answer is “Rifampicin plus clarithromycin for 8 weeks”. This is PCR-confirmed Buruli ulcer. WHO now recommends an oral 8-week course of rifampicin plus clarithromycin for every disease form, combined with wound care and selective surgery or rehabilitation according to extent. Two weeks of rifampicin–streptomycin is inadequate, clarithromycin monotherapy risks resistance, excision without antimicrobials ignores antibiotic sterilization and may cause avoidable tissue loss, and standard four-drug tuberculosis therapy adds medicines without an evidence-based role against M. ulcerans.

Reference: WHO: Buruli ulcer control strategy and treatment: https://www.who.int/teams/control-of-neglected-tropical-diseases/buruli-ulcer/objective-and-strategy-for-control-and-research