Lymphocutaneous type of nocardiosis caused by Nocardia vinacea in a patient with polymyositis.
We report a lymphocutaneous type of nocardiosis caused by Nocardia vinacea. A 62-year-old woman with polymyositis presented with some erythematous swellings and subcutaneous abscesses on her right middle finger and the dorsum of her hand, which had persisted for 2 weeks. Culturing of the excised nodule and pus revealed orange to orange-tan colonies with scanty whitish aerial mycelia. The isolate was identified as N. vinacea on the basis of its biochemical and chemotaxonomic characteristics and the results of molecular biological analysis. In our case, oral minocycline (MINO) and trimethoprim-sulfamethoxazole (TMP-SMX) for 7 weeks did not improve the clinical manifestation, even though in vitro susceptibility testing of the isolate predicted its susceptibility to MINO and TMP-SMX. Treatment with partial surgical excision followed by TMP-SMX and meropenem administration was effective. This is the first reported case of a lymphocutaneous type of nocardiosis caused by N. vinacea.
Department of Dermatology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan. m-takahashi@faculty.chiba-u.jp
Mari T
MT
Iwasawa
Yaei
Y
Togawa
Noriaki
N
Kamada
Naotomo
N
Kambe
Hiroyuki
H
Matsue
Katsukiyo
K
Yazawa
Takashi
T
Yaguchi
Yuzuru
Y
Mikami
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015373:Bacterial Typing Techniques; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D003646:Debridement; D005260:Female; D006801:Humans; D000077731:Meropenem; D008911:Minocycline / Q000008:administration & dosage; D009615:Nocardia / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D009617:Nocardia Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D017285:Polymyositis / Q000150:complications*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D013845:Thienamycins / Q000008:administration & dosage; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S; D013845:Thienamycins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077731:Meropenem; D008911:Minocycline
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