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Dumic I, Brown A, Magee K, Elwasila S, Kaljevic M, Antic M, Igandan O, Cardozo M, Rueda Prada L, Paulson M. Primary Lymphocutaneous Nocardia brasiliensis in an Immunocompetent Host: Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58040488. [PMID: 35454327 PMCID: PMC9030709 DOI: 10.3390/medicina58040488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Nocardia spp. is a Gram-positive, partially acid-fast aerobic bacterium usually associated with infection in immunocompromised people. The most common sites of infection are the skin, lungs, and the brain, however disease can disseminate and affect every organ. Clinical manifestations of cutaneous disease are varied and frequently misdiagnosed. We present a case of an immunocompetent 66-year-old man who sustained a left finger injury while gardening. He was misdiagnosed on several occasions and treated with inappropriate antibiotics against Streptococcus spp. and Staphylococcus spp. When infection spread cutaneously, sporotrichoid (lymphocutaneous) nocardiosis was suspected and the patient was started on appropriate therapy with Bactrim which resulted in a cure. We also summarize the literature on lymphocutaneous infection by Nocardia brasiliensis. By reporting this case, we want to raise awareness among clinicians about unusual causes of cellulitis, the differential diagnosis of lymphocutaneous infection and the importance of obtaining a detailed exposure history to assist in the prompt diagnosis of nocardiosis.
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Affiliation(s)
- Igor Dumic
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA; (O.I.); (M.C.); (L.R.P.); (M.P.)
- Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA
- Correspondence:
| | - Alethea Brown
- Hospital Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Kyle Magee
- Department of Microbiology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Sammer Elwasila
- Department of Infectious Disease, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Marija Kaljevic
- Department of Hospital Medicine, University of Connecticut, Hartford, CT 06032, USA;
| | - Marina Antic
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA;
| | - Oladapo Igandan
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA; (O.I.); (M.C.); (L.R.P.); (M.P.)
- Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA
| | - Milena Cardozo
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA; (O.I.); (M.C.); (L.R.P.); (M.P.)
- Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA
| | - Libardo Rueda Prada
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA; (O.I.); (M.C.); (L.R.P.); (M.P.)
- Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA
| | - Margaret Paulson
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA; (O.I.); (M.C.); (L.R.P.); (M.P.)
- Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA
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