A Primary Cutaneous Nocardiosis of the Hand

Abstract

BACKGROUNDNocardiosis is caused by an aerobic actinomycete, most commonly introduced through the respiratory tract. The Nocardiae are gram-positive, partially acid-fast bacteria. Primary cutaneous nocardiosis infections are rare and caused by the traumatic introduction of organisms percutaneously. The manifestation is usually an opportunistic infection. Cutaneous involvement may develop as one of four types: mycetoma, lymphocutaneous infection, superficial skin infection, or systemic disease with cutaneous involvement. Diagnosis and evaluation of appropriate specimens are principally by culture.CASE PRESENTATIONA 55-year-old female patient with diabetes type II presented with chronic skin lesions on the hand. Otherwise, her medical history was unremarkable. There were no signs of systemic disease. Direct examination of swabs demonstrated gramme bacteria and culture on Sabouraud agar was positive for Nocardia spp. The specimen of nocardiae was not identified. The patient was treated during nine months with sulfamethoxazole plus trimethoprim. There was an important clinical improvement of the cutaneous aspect of the lesions in hand. Some scars and fibrosis remained after nocardiosis.CONCLUSIONSPrimary cutaneous nocardiosis of the hand is a rare condition. The clinical diagnosis is difficult, and culture is mandatory.

Primary Cutaneous Nocardiosis in an Adolescent with Crohn Disease

“…In this case, primary cutaneous nocardiosis occurred in an adolescent with CD undergoing treatment with azathioprine and adalimumab, two immunosuppressive agents. While it is likely that immunosuppression played a role in the pathogenesis of this patient's infection, primary cutaneous nocardiosis has also been reported to occur in immunocompetent individuals [ 1 , 3 , 6 ]. The majority of cases of primary cutaneous nocardiosis present as a localized superficial infection often with a nodular or pustular appearance as seen in our patient.…”

“…Although not as sensitive as culture, smear or touch preparation from skin biopsy specimens can be stained with Gram stain or acid-fast stain and facilitate rapid diagnosis within an hour [ 9 , 10 ]. Interestingly, N. nova was isolated in our patient despite the most frequently isolated species being N. brasiliensis , followed by N. asteroids and N. otitidiscaviarum [ 6 , 8 ]. Other diagnoses to maintain in the differential include superficial skin infections caused by Staphylococcus aureus and Streptococci species [ 7 ].…”

Primary Cutaneous Nocardiosis: A Rare Presentation of Nocardiosis

“…Nocardia is a gram-positive, acid-fast bacteria and is classified under the family of Nocardiaceae, order Actinomycetales, suborder Corynebacterineae. The species which is most commonly associated with cutaneous nocardiosis is N. brasiliense (80% of the cases) [1, 5-7].…”

Sporotrichoid Skin Infection Caused by Nocardia brasiliensis in a Kidney Transplant Patient

“…Different acquisition modes of cutaneous nocardia infection have been described, including motor vehicle injury [ 28 ] or puncture wounds related to gardening activities [ 29 , 30 ] but in some cases, the mode of acquisition is unknown [ 31 ]. Morphologically, the lesions may be in the form of ulcers, abscesses, granulomas, other soft tissue lesions and lymphocutaneous infection [ 32 ].…”