Primary cutaneous nocardiosis in a husband and wife

Nocardia Infections of the Face and Neck

“…Facial Nocardia infections have also been described in adults without a history of trauma [22,32]. Nonetheless, the majority of cases of Nocardia affecting the neck and face in immunocompetent adults have been associated with local trauma: from thorns, abrasions following falls to the ground, being hit by a shovel, and motor vehicle accidents leading to facial injuries (Table 1) [5,7,8,11,12,28,29,31,36].…”

“…Fever may be present, and the lesions fail to respond to conventional antibiotic therapy. In adults, lymphocutaneous nocardiosis affecting the neck and face may manifest as pustules, ulcers, or suppurating abscesses surrounded by cellulitis, with associated regional lymphadenopathy that follows trauma a few weeks before [5,7,11,12,29]. Swelling may be present around the site of inoculation.…”

“…Many patients with face and neck nocardiosis have required incision and drainage of the lesion or abscess [7,11,[27][28][29][30]; early drainage avoids unnecessary morbidity. Indications for aspiration, drainage, or excision of abscesses are similar to those for other chronic bacterial infections (ie, abscesses that are accessible and relatively large, or lesions that progress despite antimicrobial therapy).…”

“…Clinical data are limited regarding the use of macrolides (eg, clarithromycin) to treat Nocardia infection of the face and neck. Oral clindamycin was used in a single patient with typical cervicofacial infection [11] forms of immunosuppression, empirical combination therapy is generally commenced pending susceptibility test results in these patients. In these settings, amikacin and imipenem (or meropenem) is a suitable regimen, but it should be noted that imipenem is not active against many strains of N. brasiliensis (Table 2).…”

“…Initially described in children, this entity is also recognized in adults [5,7,9,10]. To date, descriptions of face and neck infections have been restricted to case reports of one or more of the above forms of infection [5,7,[10][11][12]. Unlike disseminated nocardiosis, which is associated with immune compromise such as that from HIV/AIDS and organ transplantation, primary cutaneous nocardiosis usually affects immunocompetent hosts [1•, 13, 14•].…”