A very late paradoxical reaction occurring following antibiotic treatment of Buruli ulcer.

We report a very delayed paradoxical reaction presenting more than 4 years after antibiotic treatment of Buruli ulcer that settled without further antibiotic treatment. Our report aims to alert clinicians to this possibility to avoid misdiagnosis of relapsed infection and unnecessary antibiotic re-treatment which can be associated with toxicity, inconvenience and cost for the patient.