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The second patient was a 44-year-old man who had 22 × 12 cm ulcer on the front, lower aspect of his left leg that was surrounded by a dusky red, inflammatory, undermined edge.
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Eccentric one-sided bulges are sometimes accompanied by haemorrhagic content within the aortic wall on non-contrast CT imaging and subtle undermined edges on CTA (Fig. 6).
All patients had ulcers with typical undermined edges.
For bacteriologic diagnosis, 4 samples were taken with sterile cotton swabs from beneath the undermined edges of the ulcer.
Only rarely were descriptions given of the edges, and the size: "Category II wound, this is a typical BU wound with undermined edges".
Buruli ulcer usually starts as a single painless subcutaneous nodule or papule, which later moves to form an ulcer with undermined edges (30 ).
Over a few weeks, these lesions break down to form characteristic ulcers with undermined edges, which are associated with extensive necrosis alongside minimal inflammatory response.
Smears obtained by scalpel or swab were prepared with material from the necrotic base and undermined edges of the lesions and were stained with Ziehl-Neelsen.
M. ulcerans produces a potent toxin known as mycolactone (2 ), which lyses dermal cells, leading to the development of continuously expanding ulcers with undermined edges.
Clinical diagnosis of chancroid is often based on the appearance of the ulcer, which is characteristically painful, purulent, and deep with ragged, undermined edges.
Despite this therapy, the ulcer continued to enlarge, reaching 16 × 10 cm with deeply undermined edges and necrosis of the surrounding skin.
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