The transmission of Mycobacterium ulcerans (MU), the causative agent of BU, remains elusive.1 It has long been thought that the transmission of MU from a freshwater environment to ‘dead‐end’ human hosts most likely occurs from contact with traumatized skin.1, 2 The variability in BU incidence and severity between countries have driven the scientific community to focus on the diversity of MU strains and mycolactone types.1 Here, we looked at BU cases for the potential presence of co‐infections from several mycobacteria or infections from mycobacteria species other than MU, which could explain the observed BU variability.