Disseminated subcutaneous nocardiosis caused by Nocardia farcinica diagnosed by FNA biopsy and 16S ribosomal gene sequencing.
Nocardia is an infrequent but significant cause of infections in the immunocompromised host. Clinical syndromes are varied and ranges from pulmonary, disseminated, cutaneous, and CNS involvement. Here we describe a case of disseminated subcutaneous nodules in a patient with multiple myeloma caused by Nocardia farcinica. The diagnosis was made by FNA biopsy which revealed gram positive filamentous bacilli in background of acute inflammation on smears. This was confirmed by 16S ribosomal gene sequencing. Prompt identification of N. farcinica is important because of its intrinsic resistance to broad spectrum cephalosporins and high risk of dissemination.
Angeles
Ronald M
RM
Section of Cytopathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. summa100@yahoo.com
Lasala
Rocco P
RP
Fanning
Cristina V
CV
D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D024901:Drug Resistance, Multiple, Bacterial; D005840:Gentian Violet; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009615:Nocardia / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D010619:Phenazines; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D017422:Sequence Analysis, DNA; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
D000890:Anti-Infective Agents; C035863:Gram's stain; D010619:Phenazines; D012336:RNA, Ribosomal, 16S; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D005840:Gentian Violet