Disseminated subcutaneous Nocardia asteroides abscesses in a patient after bone marrow transplantation.
We describe an unusual case of disseminated subcutaneous abscesses caused by Nocardia asteroides in a 17-year-old female with AML undergoing allogeneic BMT. She was receiving immunosuppressive therapy with CYA and a corticosteroid for acute GVHD, and maintenance therapy with ganciclovir for interstitial pneumonia (IP) caused by CMV, but was not neutropenic. The subcutaneous abscesses spread from the primary infection on her right anterior leg to both thighs, the left buttock, both upper arms, the left forearm and right shoulder, indicating hematogenous dissemination. Nocardia asteroides was identified from biopsy material in culture. The patient was successfully treated with a combination of trimethoprim/sulfamethoxazole (TMP/SMX) and minocycline, given for 3 months. The possibility of nocardiosis should be considered in the differential diagnosis of such patients.
Hodohara
K
K
Second Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan.
Fujiyama
Y
Y
Hiramitu
Y
Y
Sumiyoshi
K
K
Kitoh
K
K
Hosoda
S
S
Sugiura
H
H
D000038:Abscess / Q000209:etiology* / Q000382:microbiology; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000601:surgery*; D015122:Mercaptopurine / Q000008:administration & dosage / Q000009:adverse effects; D009503:Neutropenia / Q000209:etiology; D009617:Nocardia Infections / Q000453:epidemiology / Q000209:etiology*; D009616:Nocardia asteroides / Q000302:isolation & purification*; D009894:Opportunistic Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D012074:Remission Induction; D012874:Skin Diseases, Infectious / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology
D003561:Cytarabine; D011239:Prednisolone; D015122:Mercaptopurine; D003630:Daunorubicin