2016 Volume 78 Issue 4 Pages 386-390
An 85-year-old man who worked as a farmer presented with a several-day history of swelling and erythema on his left arm.He had received oral administrations of prednisolone and immunosuppressive drugs for rheumatoid arthritis for 10 years.Hefell after slipping in the dirt at the cow shed and injured his left arm in June 2014.Hewas treated with steroid mini-pulse and lamivudine for acute hepatitis B early in July.Twoweeks later, his left arm had swelling and a blood blister. He was initially diagnosed as having necrotizing fasciitis and was treated by surgical debridement.Bacterialculture and PCR analysis of the pus and surgical tissue samples demonstrated the presence of Nocardia niigatensis.Wemade a diagnosis of primary cutaneous nocardiosis by Nocardia niigatensis without disseminated involvement.From the same time, an asymptomatic subcutaneous cyst on his right dorsal pedis had been growing in size.Thecyst was incised for pus drainage and we identified the causative fungus as Exophiala jeanselmei by PCR.Weherein report a rare case of primary cutaneous nocardiosis and phaeohyphomycosis in an immunocompromised host and review the related literature.
