Abstract
A 52-year-old man injured his left arm in a traffic accident 20 years previously and the wound had been sutured. Three years before the consultation at our clinic, the lesion swelled. A MRI revealed subcutaneous abscesses, and he was treated with surgical excision. Several months later, because of frequent exacerbation of the nodules and abscesses on the same lesion, multiple surgical resections were performed. No favorable clinical response was observed in combination with oral administrations of several antibacterial and antifungal agents. He visited our clinic for further investigation on May 10, 2007. There were some tumors and abscesses that were 2 cm in diameter, with fistulas on the previous scars. Grains in the abscess and granulomas were observed in the skin biopsy specimen. Nocardia transvalensis was isolated from the culture of the sample. No other underlying disease was detected by brain and pulmonary CT. The patient was diagnosed with mycetoma/primary cutaneous nocardiosis. He was successfully treated with oral and intravenous administration of minocycline hydrochloride, topical sulfadiazine silver, and thermotherapy.
