Background Buruli ulcer is one of the neglected tropical diseases. It is a chronic, debilitating, necrotising disease of the skin and soft tissue caused by Mycobacterium ulcerans. Most times, the pattern of presentation is neglected by the infected because it is regarded as a disease of the poor who have little or no access to healthcare. Living in rural often inaccessible areas and suffering from a triad of ignorance, stigma and poverty, this poor population fails to present early to a hospital.

Methods A retrospective review of patients who accessed care at the infectious disease clinic of Nnewi Diocesan Hospital, Nnewi, Southeast Nigeria, between 1 January to 31 December 2017. To achieve a complete inference, the results of laboratory wound swab culture of all patients were collated and matched with the clinical presentation. All cultures were done by a trained scientist of the German Leprosy and TB Relief Association (GLRA).

Results Review of data showed a total of 10 120 patients of which 6402 were outpatients and 3718 were inpatients; they were between 1 and 86 years of age. There were 60 cases of limb ulcers of which wound swab culture was done. Fifty-four (54) were diabetic foot ulcers while five (5) were venous ulcers. Acid-fast bacilli were detected with Ziehl-Neelsen staining in one specimen and confirmed by the reference center.

Conclusion Most of the Buruli ulcer patients are found incidentally following late presentation at hospitals with a questionable ulcer/wound with a high index of suspicion on clinical examination. If Buruli ulcer is to be eradicated, an intensive rural epidemiological identification programme must be implemented to isolate the infected. The vicious cycle of ignorance, stigma and poverty needs to be broken by massive awareness and education campaigns.