Primary Cutaneous Nocardiosis in an Adolescent with Crohn Disease

Abstract

Nocardia is an aerobic, Gram-positive, partially acid-fast bacterium that often manifests as pulmonary infection since the primary route of entry is via the respiratory tract. As an opportunistic organism, Nocardia primarily affects immunocompromised individuals. Infection with Nocardia is uncommon. Primary cutaneous nocardiosis which is caused by percutaneous inoculation is even more rare. Here, we report a case of primary cutaneous nocardiosis in an adolescent with Crohn disease receiving treatment with adalimumab and azathioprine. Early identification and treatment are important to prevent disease progression and to avoid severe complications. Diagnosis is made principally by culture. Given that culture results may take up to two weeks to return, primary cutaneous nocardiosis should be maintained in the differential for any superficial cutaneous infection that arises in individuals undergoing treatment with immunosuppressive agents.

Diagnosis of cutaneous primary nocardiosis in patients with normal immune function by metagenomic next‐generation sequencing

“…Infection with Nocardia is uncommon and primary cutaneous nocardiosis caused by percutaneous inoculation is even rarer. 2 Primary cutaneous Nocardia infection in clinical practice predominantly manifests as skin pustules, pustulosis, abscesses, ulcers, granulomas or cellulitis; these infections are mostly caused by infection with Nocardia brasiliensis. 3 Herein, we report a case that was diagnosed with primary cutaneous Nocardia by metagenomic next-generation sequencing (mNGS) technology.…”

“…As an opportunistic organism, Nocardia primarily affects immunocompromised individuals. Infection with Nocardia is uncommon and primary cutaneous nocardiosis caused by percutaneous inoculation is even rarer 2 . Primary cutaneous Nocardia infection in clinical practice predominantly manifests as skin pustules, pustulosis, abscesses, ulcers, granulomas or cellulitis; these infections are mostly caused by infection with Nocardia brasiliensis 3 .…”