Primary cutaneous nocardiosis

Seven patients with primary cutaneous nocardiosis were seen during a 20-month period. Six patients had a history of local trauma to an extremity or did frequent yard work. The spectrum of clinical disease included cellulitis, pustules,pyoderma, or lymphocutaneous syndrome mimicking sporotrichosis. Evidence of Nocardia infection elsewhere was absent, and no patient had a serious underlying disease. Nocardia brasiliensis was isolated from four cases, and N asteroides was identified in the other three patients. In two patients, disease resolved without chemotherapy, while a short course of a sulfonamide with or without trimethoprim therapy was successful in the remaining cases. The relatively benign nature of this disease, the usual failure to obtain cultures of superficial skin infections, and our accumulation of seven cases in less than two years suggest this disease is more common than previously recognized.