Primary Cutaneous Nocardiosis: A Rare Presentation of Nocardiosis

Abstract

Nocardia is an uncommon gram-positive, weakly acid-fast bacterium that causes systemic or localized suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of the patients are immunocompetent. The most common presentation is pulmonary disease (39%) followed by systemic involvement, defined as involvement of more than two sites; cutaneous presentation constitutes only 8% of the cases. Nocardia is widely distributed geographically; however, in the US, it is mostly found in warm and dry areas of South West and South East. We present a perfect case of cutaneous nocardiosis of a 70-year-old male, who presented with a traumatic splinter injury, leading to pustules formation on the right index finger, along with erythema and induration of the right arm. The patient was empirically diagnosed and treated for cellulitis, with amoxicillin and clavulanic acid, resulting in deterioration of the wound. The patient underwent incision and drainage and wound culture grew nocardia. The index of suspicion should be kept in mind while treating infectious blisters which have failed outpatient cellulitis treatment, immunocompromised hosts, and in nocardia prevalent regions.

Primary Cutaneous Nocardiosis in an Adolescent with Crohn Disease

“…However, progression to cellulitis or abscess formation can occur [ 7 ]. Other manifestations may include lymphocutaneous involvement and mycetomas [ 8 ].…”

“…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 ].…”

“…Although Nocardia infection is uncommon, primary cutaneous nocardiosis which is caused by direct skin inoculation is exceptionally rare [ 4 – 8 ]. Cutaneous infection may be characterized by nodules, ulcerations, pyoderma, cellulitis, or subcutaneous abscess formation [ 4 ].…”

Síndrome linfocutáneo de causa infecciosa: revisión narrativa y enfoque diagnóstico

“…Se han reportado varios casos asociados a punción traumática con SLC, así como la realización de actividades como agricultura o jardinería, y arañazo de gato (2) . Hay predilección por hombres (4:1), lo que probablemente refleja la ocupación (2,40) .…”

“…Las imágenes (ultrasonido, tomografía y resonancia magnética) son útiles para definir la extensión de las lesiones, facilitar la toma de muestras en sitios específicos y definir la pertinencia de drenaje quirúrgico o desbridamiento (39) . En inmunocomprometidos, se debe descartar compromiso extenso pulmonar o cerebral (39,40) .…”