Cutaneous nocardiosis on exit site of peritoneal dialysis catheter

Abstract

We present the case of a 48‒year‒old female who had received peritoneal dialysis (PD) for 7 years after preeclampsia. She had also developed rheumatoid arthritis and psoriasis, treated with corticosteroid and trimethoprim‒sulfamethoxazole. She presented with white‒yellow and cream‒like purulent discharge from the PD catheter‒epidermal interface. Empiric antibiotic therapies were initiated with cephem and a new quinolone agent, which failed to resolve the infection. Nocardia was identified after culture of purulent drainage from the exit‒site swab. To classify the species, 16S rRNA gene sequencing analysis was carried out and antimicrobial susceptibility was tested. As a result, Nocardia farcinica was identified and found to be susceptible to oral antibiotics such as trimethoprim‒sulfamethoxazole and AMPC/CVA. The patient then received an agent that led to the disappearance of purulent discharge. Discharge of pus from the exit site recurred； however, antibiotic therapies were continued for 2‒3 months. As a result of recurrence, we discontinued antibiotic therapies. Removal of the old PD catheter and insertion of a new catheter on the opposite side led to no new episode of recurrence. Refractory catheter‒related infection raises the suspicion of atypical organisms, including Nocardia. We describe the first reported case in over 30 years of PubMed surveys of cutaneous nocardiosis on the exit site of a PD catheter.