title: Cutaneous nocardiosis: report of two cases and review of the literature.
abstract: BACKGROUND
  Cutaneous nocardiosis is an uncommon infectious disease that presents as a primary cutaneous infection or as a disseminated disease. It is often misdiagnosed because of its rarity and nonspecific clinical picture.
  
  
  METHODS
  We report a case of each type. The first case is an immunocompetent patient who was infected by Nocardia while gardening and developed a superficial skin infection--one of the three clinical manifestations of primary cutaneous nocardiosis. The second case is an immunocompromised patient with pulmonary nocardiosis that extended to the skin as part of a disseminated disease.
  
  
  RESULTS
  The immunocompetent patient with primary cutaneous nocardiosis had the classical features of a superficial skin infection. He had a nodular–pustular lesion on the right arm, which appeared 7 days after gardening with bare hands. Nocardia was identified in a skin culture taken from a pustule, unfortunately not to the species level. Treatment with minocycline for 3 months resulted in full remission of the lesion. The immunocompromised patient with disseminated nocardiosis had high fever, productive cough, hemoptysis, and erythematous nodules and pustules on the extremities. N. brasiliensis was isolated from bronchial samples and skin. Treatment with a high dose of trimethoprim and sulfamethoxazole for five months resulted in full recovery from cutaneous and pulmonary complaints. No relapse of the infection was found on follow-up in either patient.
  
  
  CONCLUSIONS
  These cases demonstrate the need for a high degree of suspicion, focused clinical search, and appropriate laboratory procedures in the diagnosis and management of cutaneous nocardiosis.
authors.affiliation: Department of Dermatology, Ha’emek Medical Center, Afula, Israel.
authors.forename: Roni
authors.initials: R
authors.lastname: Dodiuk-Gad
authors.forename: Eran
authors.initials: E
authors.lastname: Cohen
authors.forename: Michael
authors.initials: M
authors.lastname: Ziv
authors.forename: Lee Hilary
authors.initials: LH
authors.lastname: Goldstein
authors.forename: Bibiana
authors.initials: B
authors.lastname: Chazan
authors.forename: Jan
authors.initials: J
authors.lastname: Shafer
authors.forename: Hannah
authors.initials: H
authors.lastname: Sprecher
authors.forename: Mazen
authors.initials: M
authors.lastname: Elias
authors.forename: Yoram
authors.initials: Y
authors.lastname: Keness
authors.forename: Dganit
authors.initials: D
authors.lastname: Rozenman
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use; D009615:Nocardia / Q000187:drug effects / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology*; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013420:Sulfamethoxazole / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D014295:Trimethoprim; D008911:Minocycline; D013420:Sulfamethoxazole