Gardener with primary lymphocutaneous nocardiosis

• Published in: BMJ case reports Vol. 12; no. 12; p. e233586
• Main Authors: Abu Sitta, Emad, Hollingshead, Caitlyn, Luttmann, Kelly, Elsaghir, Hend
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 15-12-2019; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotics; Case reports; dermatology; Drainage; Female; Gardening; Humans; Images In; Infections; infectious diseases; Laboratories; Literature reviews; Middle Aged; Nocardia - isolation & purification; Nocardia Infections - diagnosis; Nocardia Infections - therapy; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; dermatology; infectious diseases
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-233586

Laboratory investigations were significant for a white cell count of 11.4×109/L, C-reactive protein of 4.1 mg/dL (normal 0–0.74 mg/dL) and an erythrocyte sedimentation rate of 36 mm/hour. The organism was identified using MALDI TOF MS (Matrix Assisted Laser Desorption/Ionization Mass Spectrometry) as Nocardia brasiliensis. N. brasiliensis is an aerobic gram-positive bacterium with the ability to cause localised and systemic infections, especially in immunocompromised patients.1 Nocardia localised cutaneous and lymphocutaneous infections have been reported after the organism enters the host through the skin.2 Exposure to soil and mulch is a risk factor for development of nocardiosis, especially with an open wound.