[Nodular lymphangitis caused by Nocardia asteroides].
BACKGROUND
Nocardia species are typically found in soil and decaying organic matter. The lymphocutaneous type or nodular lymphangitis is unusual. This is acquired in most of cases by a traumatic inoculation through the skin of a person who is immunocompetent, and is generally caused by Nocardia brasiliensis.


METHODS
We report two cases of nodular lymphangitis caused by Nocardia asteroides, that have been admitted in our hospital during one year period.


RESULTS
The two healthy persons of 26 and 56 years old suffered from a cutaneous puncture in their arms caused by a plant's pricke while they were gardening. The symptoms they showed at the area of the puncture were ulcerative lesion and inflammatory nodules through the lymphatic tract that were abscessed. There were not any systemic involvement. Cultures of the purulent drainage and skin biopsy revealed Nocardia asteroides. Treatment with oral trimethoprim-sulfamethoxazole for 8 weeks and surgical debridement resulted in a cure without relapse.


CONCLUSIONS
Nodular lymphangitis has specific symptoms and clinical signs. A detailed clinical and occupational history, accompanied by microbiology identification at the cutaneous biopsy and exudation, should allow specific treatment. Trimethoprim-sulfamethoxazole continues being the selected antibiotic.
Comellas
J
J
Sección de Enfermedades Infecciosas, Hospital Asepeyo, Sant Cugat, Barcelona.
Morales
M
M
Granell
F
F
D000328:Adult; D005260:Female; D006801:Humans; D008205:Lymphangitis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections; D009616:Nocardia asteroides; D014950:Wounds, Penetrating / Q000382:microbiology