Atypical Mycobacterium ulcerans Infection with Skip Lesions in a 68-Year-Old Male: A Rare Case and Comprehensive Literature Review.

Background/Objectives:Mycobacterium ulcerans causes Buruli ulcers, typically manifesting as a single progressive necrotizing skin lesion. Rarely, non-contiguous "skip lesions" occur, complicating diagnosis and management. This report describes an atypical case and reviews similar presentations to emphasize early recognition and combined therapeutic strategies. Methods: A systematic literature review was performed using PubMed, Embase, Cochrane Library, Google Scholar, and Scopus databases until December 2024, focusing on cases involving skip lesions. Additionally, a detailed clinical case of a 68-year-old male from Mornington Peninsula, Australia, presenting skip lesions from the distal leg to the proximal knee was documented, including diagnostic PCR testing, surgical interventions, and antibiotic treatments. Results: Twelve studies were identified, totaling 1828 cases with 1179 exhibiting skip lesions. The majority achieved successful outcomes through combined antibiotic (rifampicin and clarithromycin) and surgical management. The reported case initially underwent surgical excision without antibiotics, leading to recurrence. Subsequent comprehensive management combining additional surgical debridement and adjusted antibiotics successfully resolved the infection. Conclusions: Although rare, skip lesions significantly complicate the clinical management of Buruli ulcers. Early diagnosis and a multidisciplinary approach integrating surgical debridement and antibiotic therapy are critical for optimal outcomes and minimizing recurrence risks.