 This eight-year-old pupil presented with a subcutaneous nodular lesion which was not attached to the underlying tissue, it was not warm and non-tender. FNA obtained from this lesion was positive for M. ulcerans. A diagnosis of brule ulcer nodule Category 1 was made and the treatment streptomycin rifampicin for eight weeks was commenced according to the WHO recommendations. At zero weeks the estimated dimensions of the lesion was 20.25 cm2. There was a progressive decline in the lesion surface area with treatment such that at two weeks the dimensions were 19.6 cm2, at four weeks it was 10.6 cm2, at six weeks it was 3.3 cm2, eight weeks it was 1.9 cm2 and the lesion finally healed at 12 weeks without any functional limitation to the elbow joints. This demonstrates the excellent clinical efficacy of the combination streptomycin rifampicin and also highlights that lesions should be treated early. Had this nodular lesion not been treated the lesion would have gone on to ulcerates and may have resulted in complications such as physical restriction at the elbow joints.