The localisation of treponemes in skin biopsies.

Abstract

As an antibiotic of choice pulmonary nocardia was initially treated with high dose oral cotrimoxazol but discontinued after 8 days due to cotrimoxazole related severe itchy rash involving the extremities and oral mucosa. Subsequently he was treated with parentral ceftazidine and doxycycline for 2 weeks followed by doxycycline maintenance therapy for 4 months. The temperature and the upper lobe consolidation resolved slowly with some residual consolidation despite 4 months of therapy.Kim et al 3 and Kramer et al 4 have suggested that nocardia may be increasing in frequency in patients with immunodeficiency due to HIV infection.This case illustrates the diagnostic and therapeutic difficulties associated in the management of nocardia. To our knowledge this is the first case of pulmonary nocardia in a Caucasian born in the UK who has never been to Africa.