title: Actinomycetoma by Nocardia brasiliensis in a girl with Down syndrome.
abstract: We describe the case of a 14-year-old girl with Down syndrome and a large cutaneous plaque localized to the right neck and shoulder that had enlarged over five years after a minor traumatic injury. The plaque was characterized by numerous inflammatory nodules and fistulae that secreted purulent discharge. Nocardia grains were identified and Nocardia brasiliensis was identified by culture. Histopathology examination showed a chronic inflammatory infiltrate with granuloma development. The treatment scheme was with Diaminodiphenylsulfone 50/mg/d and Trimethoprim-Sulfamethoxazole 800/160 mg BID. Therapy was continued over 1(1/2) years, with a tapering dose. After 2(1/2) years of continuous treatment, clinical and microbiological healing was achieved.
authors.affiliation: Dermatology Department, Hospital Infantil de Mexico Federico Gomez.
authors.forename: Martha
authors.initials: M
authors.lastname: Pardo
authors.forename: Alexandro
authors.initials: A
authors.lastname: Bonifaz
authors.forename: Adriana
authors.initials: A
authors.lastname: Valencia
authors.forename: Javier
authors.initials: J
authors.lastname: Araiza
authors.forename: Silvia Anett
authors.initials: SA
authors.lastname: Mejia
authors.forename: Carlos
authors.initials: C
authors.lastname: Mena-Cedillos
mesh_terms: D000293:Adolescent; D003622:Dapsone / Q000627:therapeutic use; D003951:Diagnostic Errors; D004314:Down Syndrome / Q000150:complications*; D002523:Edible Grain / Q000382:microbiology; D005260:Female; D006099:Granuloma / Q000209:etiology / Q000382:microbiology; D006801:Humans; D008271:Mycetoma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D009333:Neck; D009615:Nocardia / Q000254:growth & development / Q000302:isolation & purification; D009617:Nocardia Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D018520:Plant Shoots / Q000382:microbiology; D000070599:Shoulder Injuries; D012883:Skin Ulcer / Q000209:etiology / Q000382:microbiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014382:Tuberculosis, Cutaneous / Q000175:diagnosis; D014946:Wound Infection / Q000150:complications / Q000382:microbiology
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003622:Dapsone