Compressive myelopathy due to nocardiosis from dermal lesion

Nocardiosis refers to locally invasive or disseminated infection associated with Nocardia species. Most infections enter through respiratory tract and then disseminate systemically. Rarely primary nocardial infection of the skin of the back may spread to contiguous structures including vertebrae. A 30 years male presented with indolent skin lesion in the upper dorsal region of the back for one year following an accident and subsequently developed features of spinal cord compression and parenchymal involvement of lung. The rarity of such type of spread in an immuno-competent individual has been highlighted.