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Soil-acquired cutaneous nocardiosis on the forearm of a healthy male contracted in a swamp in rural eastern Virginia

Authors Palmieri JR, Santo A, Johnson S

Received 17 December 2013

Accepted for publication 18 January 2014

Published 7 March 2014 Volume 2014:7 Pages 41—47


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

James R Palmieri,1 Arben Santo,2 Shawn E Johnson1

1Department of Microbiology, Infectious and Emerging Diseases, 2Department of Pathology, Edward Via College of Osteopathic Medicine, Virginia Campus, Blacksburg, VA, USA

Abstract: A 45-year-old man complained of pain and swelling on his right wrist after receiving a scratch while playing paintball in a swampy area of eastern Virginia. Two weeks later, he noticed a pimple-like lesion developing, which quickly grew in size and then ulcerated. Because of the severity of his condition, the patient was taken to the emergency room where surgical drainage of the abscess was carried out and the pus was sent for culture and sensitivity testing. Enlarged and tender lymph nodes were palpable going up the arm and surrounding the right axillary area. Three days following culture of pus from his lesion, colonies of Nocardia brasiliensis were isolated. He was successfully treated with an extended regimen of trimethoprim-sulfamethoxazole. Because of its low incidence, nocardiosis is usually not considered in the initial diagnosis. The rapidity with which his infection developed from a pimple-like lesion into an extensive ulcerated area, the involvement of his lymphatic system, the extended time needed to successfully treat his infection, and the potential for infection to rapidly disseminate, reinforces the necessity for laboratory identification and immediate treatment of severe pyogenic cutaneous lesions.

Keywords: actinomycetes, cutaneous nocardiosis, immunocompromised, mycetoma, Nocardia brasiliensis, nocardiosis, trimethoprim-sulfamethoxazole

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