title: An unusual presentation of primary cutaneous nocardiosis at a rare site: succesful treatment with a modified Welsh regimen.
abstract: BACKGROUND
  Primary cutaneous nocardiosis can present in various forms. Clinically, it can present as acute infection (abscess or cellulitis), mycetoma, or sporotrichoid infection. Mycetoma over the back is rare.
  
  
  METHODS
  We herein describe a case of primary cutaneous nocardiosis presenting as a mycetoma, caused by Nocardia brasiliensis. The patient had extensive lesions over the back, which can be attributed to the fact that the patient, being an agriculturist, has been exposed to recurrent trauma while carrying firewood and soiled sacks. He responded well to a modified Welsh regimen. Initially, within 2 cycles, the patient showed dramatic improvement clinically, wherein the sinuses, granulation tissue, and induration were no longer apparent. However, the patient showed a small discharging sinus at the end of 3rd pulse, so a total of 6 cycles were given. An additional 2 months of maintenance phase treatment with cotrimoxazole and rifampicin were given. On follow-up, the patient showed no recurrence at 6 months.
  
  
  CONCLUSIONS
  We report a case of primary cutaneous nocardiosis presenting as a mycetoma on the back. Enlisting the help of a microbiologist allowed us to isolate the causative organism. Early recognition and prompt treatment prevents unwarranted surgical debridement and complications.
authors.affiliation: MS Ramaiah Medical College and Teaching Hospital, Bangalore, Kamataka, India.
authors.forename: S
authors.initials: S
authors.lastname: Praveen Kumar
authors.forename: T K
authors.initials: TK
authors.lastname: Sumathy
authors.forename: A L
authors.initials: AL
authors.lastname: Shyam Prasad
authors.forename: D R
authors.initials: DR
authors.lastname: Gayathri Devi
authors.forename: K N
authors.initials: KN
authors.lastname: Shivaswamy
authors.forename: C
authors.initials: C
authors.lastname: Ranganathan
mesh_terms: D000328:Adult; D000583:Amikacin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009615:Nocardia / Q000187:drug effects / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000188:drug therapy / Q000473:pathology*; D012293:Rifampin / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin; D012293:Rifampin