Primary Subcutaneous Abscess and Osteitis Caused by Nocardia asteroides

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Dermatology

Background:

• Nocardia asteroides typically causes pulmonary infections, with cutaneous involvement often secondary to disseminated disease.
• Subcutaneous abscess and osteitis are severe manifestations of Nocardia infection.
• The infrequency of primary cutaneous Nocardia asteroides infection without pulmonary symptoms is noteworthy.

Purpose of the Study:

• To report a rare case of subcutaneous abscess and lower limb osteitis caused by Nocardia asteroides.
• To emphasize the unusual presentation of Nocardia asteroides cutaneous infection without prior pulmonary disease.
• To document the treatment response to antibiotics, specifically the ineffectiveness of sulfonamides and efficacy of pefloxacin.

Main Methods:

• Case report detailing a clinical presentation, diagnostic workup, and treatment of an 84-year-old male patient.
• Microbiological identification of Nocardia asteroides from abscess and bone tissue.
• Clinical monitoring of treatment response to antimicrobial therapy.

Main Results:

• Successful treatment of subcutaneous abscess and osteitis of the lower limb caused by Nocardia asteroides.
• Demonstration of a primary cutaneous Nocardia asteroides infection in the absence of pulmonary involvement.
• Observed resistance to sulfonamides and susceptibility to pefloxacin in this specific Nocardia asteroides isolate.

Conclusions:

• Nocardia asteroides can cause severe cutaneous and bone infections presenting primarily without pulmonary symptoms.
• Treatment of Nocardia asteroides infections may require alternative antibiotic choices when standard therapies like sulfonamides are ineffective.
• Pefloxacin demonstrated efficacy in this challenging case, suggesting its potential role in managing refractory Nocardia infections.