Primary Cutaneous Nocardiosis Due to Nocardia Farcinica: A Case Report of an Often Overlooked Infection

Figures & data

Figure 1 (A) MRI of the lower extremities showed multiple clumpy abnormal signal lesions, suspected of hematomas or abscesses formation. (B) Abnormal signal lesions decreased than before. (C) Modified Kinyoun acid-fast stain (1% sulfuric acid as a decolorizing agent) revealed red purple branching hyphae in multiple directions (10*100). (D) A routine blood agar plate at 48 hours revealed growth of small and hard white colonies.

Table 1 Clinical Characteristics of 6 Patients with Primary Cutaneous Nocardiosis Due to N.farcinica Reported in Case Reports from 2006 to 2020

Year	Age/Gender	Occupation	Clinical Manifestations	Underlying Condition	Steroids and/or Other Immunosuppressants	Therapy	Antimicrobial Susceptibility Testing	Outcome
2006^Citation6	65/F	NA	Chills, nausea, elevated body temperature (37.5°C); pain, swelling and erythema of right thigh	Hodgkin’s lymphoma	Methotrexate, vinblastine, bleomycin	TMP/SXM (3 mo)	Susceptible to AMK, AMC, CRO, IPM, TMP/SXM and MI; resistant to CIP, TOB and CLR	Cured
2008^Citation4	72/M	Mining	Painful nodules of the forearm, wrist, and buttocks	Multiple myeloma	Cyclophosphamide, dexamethasone, lenalidomide	TMP/SXM (6 mo)	Susceptible to AMK, TMP/SXM, LZD, and CIP; resistant to CRO, IPM and CLR	Cured
2011^Citation7	37/M	Farmer	Painful nodules and ulcers of left legs	HBV carrier	None	TMP/SXM	None	NA
2012^Citation8	31/F	NA	A small ulcer of right leg	NA	None	TMP/SXM (3 mo)	Susceptible to AMK and EM; resistant to CN and TOB	Cured
2013^Citation9	54/M	Gardening as a hobby	Fever (39°C); pain, swelling and erythema of left thigh	Leprosy; Diabetes mellitus	Prednisone, thalidomide	TMP/SXM and IPM (1 mo)	None	Cured
2014^Citation10	45/F	NA	Pain, swelling and erythema of right thigh	Cogan’s syndrome	Prednisolone, ciclosporin	AMC (6 mo)	Susceptible to AMC and TMP/SXM, MI, DOX and CLR	Cured

Abbreviations: AMK, amikacin; AMC, amoxicillin/clavulanic acid; CRO, ceftriaxone; IPM, imipenem; TMP/SXM, trimethoprim-sulfamethoxazole; MI, minocycline; CIP, ciprofloxacin; TOB, tobramycin; CLR, clarithromycin; LZD, linezolid; CN, gentamicin; EM, erythromycin; DOX, doxycycline; NA, not available.

Table 2 Characteristics of the Patient from This Case Report

Characteristic	Our Patient
Age/gender	55/Male
Occupation	Electrician
Main underlying conditions	Nephrotic syndrome
	Diabetes
Maximum temperature	37.8°C
Clinical manifestations	Right thigh pain
MRI results	Abscesses formation
Steroids and/or other immunosuppressants	Steroid and cyclophosphamide
Therapy	Ceftriaxone/3 days
	Piperacillin-tazobactam/4 days
	TMP-SMX/3 days
	Linezolid, TMP-SMX/19 days
	TMP-SMX, amoxicillin-clavulanate/6 months
Other therapy	Abscess drainage/10 days
Outcome/follow-up	Cured/6 months
Positive microbiology/incubation time	3 days
Pathogen	N.farcinica
Identification method	MALDI-TOF-MS
	Sequencing of the 16s rRNA genes
	Modified Kinyoun acid-fast stain
	Morphology

Malani AK, Gupta C, Weigand RT, et al. Thigh abscess due to Nocardia farcinica. J Natl Med Assoc. 2006;98:977–979.16775924

 PubMed Web of Science ®Google Scholar

Angeles RM, Lasala RP, Fanning CV. Disseminated subcutaneous nocardiosis caused by Nocardia farcinica diagnosed by FNA biopsy and 16S ribosomal gene sequencing. Diagn Cytopathol. 2008;36:266–269. doi:10.1002/dc.2080418335548

 PubMed Web of Science ®Google Scholar

Bosamiya SS, Vaishnani JB, Momin AM. Sporotrichoid nocardiosis with cutaneous dissemination. Indian J Dermatol Venereol Leprol. 2011;77:535. doi:10.4103/0378-6323.82409

 Web of Science ®Google Scholar

Jiménez GD, Albarrán PC, Galán SF, et al. Primary cutaneous nocardiosis caused by Nocardia farcinica. Rev Clin Esp. 2012;212:e49–e51. doi:10.1016/j.rce.2012.02.01522520872

 PubMedGoogle Scholar

De Nardo P, Giancola ML, Noto S, et al. Left thigh phlegmon caused by Nocardia farcinica identified by 16S rRNA sequencing in a patient with leprosy: a case report. BMC Infect Dis. 2013;13:162. doi:10.1186/1471-2334-13-16223556433

 PubMed Web of Science ®Google Scholar

Merinopoulos D, Khan H, Ginwalla S, et al. Nocardia farcinica complicating Cogan’s syndrome. Oxford Med Case Rep. 2014;2014:36–38. doi:10.1093/omcr/omu016

 Google Scholar