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Metastatic
Clinical: spread from initial lesion to distant site, usually skin and/or bone.
Histology: typical changes of BU at distant sites, or M. ulcerans-specific osteomyelitis.
This case demonstrates metastatic M. ulcerans osteomyelitis of the femur, the original lesion was at a distant skin site. The photomicrograph (left, Ziehl-Neelsen stain) shows clusters of AFB in the necrotic marrow and erosion of a trabecula.
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