A Primary Cutaneous Nocardiosis of the Hand


  • Camilla Camozzota Santa Casa de Misericórdia Hospital, Porto Alegre, Porto Alegre, RS
  • Alberto Goldman Clinica Goldman, Porto Alegre, RS
  • Georgi Tchernev Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia
  • Torello Lotti Department of Dermatology, University of Rome “G. Marconi”, Rome, Italy; Department of Biotechnology, Delft University of Technology, 2628 BC, Delft
  • Uwe Wollina Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden




Actinomycetes, Nocardiosis, Hand, Antibiosis, Sabauroud agar, Primary cutaneous infection


BACKGROUND: Nocardiosis 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 PRESENTATION: A 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.

CONCLUSIONS: Primary cutaneous nocardiosis of the hand is a rare condition. The clinical diagnosis is difficult, and culture is mandatory.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ Jr. Clinical and laboratory features of the Nocardia spp. Based on current molecular taxonomy. Clin Microbiol Rev. 2006;19:259-282. https://doi.org/10.1128/CMR.19.2.259-282.2006 PMid:16614249 PMCid:PMC1471991

Smego RA Jr, Gallis HA. The clinical spectrum of Nocardia brasiliensis infections in the United States. Rev Infect Dis. 1984;6:164-180. https://doi.org/10.1093/clinids/6.2.164

Kim YK, Sung H, Jung J, Yu SN, Lee JY, Kim SH, et al. Impact of immune status on the clinical characteristics and treatment outcomes of nocardiosis. Diagn Microbiol Infect Dis. 2016;85:482-487. https://doi.org/10.1016/j.diagmicrobio.2016.05.004 PMid:27241370

Chen B, Tang J, Lu Z, Wang N, Gao X, Wang F. Primary cutaneous nocardiosis in a patient with nephrotic syndrome: A case report and review of the literature. Medicine (Baltimore). 2016;95:e2490. https://doi.org/10.1097/MD.0000000000002490 PMid:26817885 PMCid:PMC4998259

Magalhães GM, Oliveira SC, Soares AC, Machado-Pinto J, de Resende MA. Mycetoma caused by Nocardia caviae in the first Brazilian patient. Int J Dermatol. 2010;49:56-58. https://doi.org/10.1111/j.1365-4632.2009.04263.x PMid:20465613

Du P, Hou X, Xie Y, Xu S, Li L, Zhang J, et al. Genotyping of Nocardia farcinica with multilocus sequence typing. Eur J Clin Microbiol Infect Dis. 2016;35:771-778. https://doi.org/10.1007/s10096-016-2596-x PMid:26972429

Baio PV, Ramos JN, dos Santos LS, Soriano MF, Ladeira EM, Souza MC, et al. Molecular identification of nocardia isolates from clinical samples and an overview of human nocardiosis in Brazil. PLoS Negl Trop Dis. 2013;7:e2573. https://doi.org/10.1371/journal.pntd.0002573 PMid:24340116 PMCid:PMC3854972

Condas LA, Ribeiro MG, Muro MD, de Vargas AP, Matsuzawa T, Yazawa K, et al. Molecular identification and antimicrobial resistance pattern of seven clinical isolates of Nocardia spp. In Brazil. Rev Inst Med Trop Sao Paulo. 2015;57:251-256. https://doi.org/10.1590/S0036-46652015000300012 PMid:26200967 PMCid:PMC4544251

Girard V, Mailler S, Polsinelli S, Jacob D, Saccomani MC, Celliere B, et al. Routine identification of Nocardia species by MALDI-TOF mass spectrometry. Diagn Microbiol Infect Dis. 2017;87:7-10. https://doi.org/10.1016/j.diagmicrobio.2016.09.024 PMid:27802877

Hashemi-Shahraki A, Heidarieh P, Bostanabad SZ, Hashemzadeh M, Feizabadi MM, Schraufnagel D, et al. Genetic diversity and antimicrobial susceptibility of Nocardia species among patients with nocardiosis. Sci Rep. 2015;5:17862. https://doi.org/10.1038/srep17862 PMid:26638771 PMCid:PMC4671095

Wollina U, Schönlebe J, Haroske G, Unger L, Kittner T, Tchernev G, Chokoeva AA, Lotti T. Nodular epitheloid sarcoma of the upper limb. A case report and review of the literature. J Biol Regul Homeost Agents. 2015;29(Suppl):23-26. PMid:26016962

Omer RF, Seif El Din N, Abdel Rahim FA, Fahal AH. Hand mycetoma: The Mycetoma Research Centre experience and literature review. PLoS Negl Trop Dis. 2016;10:e0004886. https://doi.org/10.1371/journal.pntd.0004886 PMid:27483367 PMCid:PMC4970814

Asgeirsson H, Sigurdardottir B. Nocardiosis in immunocompromised host presenting as cellulitis. Laeknabladid. 2010;96:423-425. PMid:20519773

Wang AW, D'Cruz M, Leung M. Primary cutaneous nocardiosis of the hand: a case report and literature review. Hand Surg. 2002;7:155-157. https://doi.org/10.1142/S0218810402000868 PMid:12365059

Ricci JA, Weil AA, Eberlin KR. Necrotizing cutaneous nocardiosis of the hand: A case report and review of the literature. J Hand Microsurg. 2015;7:224-227. https://doi.org/10.1007/s12593-015-0173-7 PMid:26078549 PMCid:PMC4461627



How to Cite

Camozzota C, Goldman A, Tchernev G, Lotti T, Wollina U. A Primary Cutaneous Nocardiosis of the Hand. Open Access Maced J Med Sci [Internet]. 2017 Jul. 20 [cited 2023 Feb. 4];5(4):470-2. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2017.106

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>