A 58-year-old Japanese male was referred to our clinic for the investigation of multiple skin abscesses on his trunk and extremities. He had noticed his lesions two months previously. Surgical debridement of his right thigh revealed subcutaneous and intramuscular abscess formation. Bacterial culture and PCR analysis of the surgical tissue samples demonstrated
Nocardia brasiliensis (
N. brasiliensis). Chest computed tomography showed the signs of pulmonary inflammation, suggesting a diagnosis of secondary cutaneous nocardiosis disseminated from the pulmonary nocardiosis. The patient was treated with trimethoprim-sulfamethoxazole and minocycline hydrochloride, resulting in improvement of both his cutaneous abscesses and pulmonary lesions.
Nocardia species are common natural inhabitants of the soil ; they frequently cause opportunistic infections in immunocompromised patients. However, only nine cases of muscular nocardiosis have been reported in Japan, including two caused by
N. brasiliensis. Disseminated nocardiosis has a poor prognosis because it often develops in immunocompromised patients, and the isolation rate of the
Nocardia is low. Only four cases of secondary cutaneous nocardiosis, including the current case, caused by
N. brasiliensis have been reported in Japan. Among them, the three other cases were all fatal. In our case, the aggressive debridement of the abscesses resulted in a rapid diagnosis and improvement of the prognosis.
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