@article{25082,
  keywords = {Reaction, Paradoxical reaction, Mycobacterium ulcerans, Maladie tropicale, French Guiana; Guyane française, Buruli ulcer},
  author = {Sambourg E and Dufour J and Edouard S and Morris A and Mosnier E and Reynaud Y and Sainte-Marie D and Nacher M and Guégan J-F and Couppié P},
  title = {[Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana].},
  abstract = {<p><strong>BACKGROUND: </strong>In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin.</p>

<p><strong>PATIENTS AND METHODS: </strong>We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years.</p>

<p><strong>DISCUSSION: </strong>In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M.&nbsp;ulcerans, resulting from the action of the antibiotics.</p>
},
  year = {2014},
  journal = {Ann Dermatol Venereol},
  volume = {141},
  pages = {413-8},
  issn = {0151-9638},
  doi = {10.1016/j.annder.2014.01.010},
  language = {fre},
}