A Primary Cutaneous Nocardiosis of the Hand

Camilla Camozzota; Alberto Goldman; Georgi Tchernev; Torello Lotti; Uwe Wollina

doi:10.3889/oamjms.2017.106

Authors

Camilla Camozzota Santa Casa de MisericÃ³rdia 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 â€œG. Marconiâ€, 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

DOI:

https://doi.org/10.3889/oamjms.2017.106

Keywords:

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

Abstract

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 organismsÂ 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.

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