Disseminated cutaneous Nocardia brasiliensis infection

Nocardia brasiliensis is an uncommon pathogen in the United States despite its presence in soil samples. It is most frequently seen in patients who are immunosuppressed, but can occur in the immunocompetent host also. Usually in a healthy host the infection is localized to one area of the body. Disseminated infection was diagnosed in a healthy child who recovered fully after initiation of oral sulfonamide therapy. We suspect that the source was soil to which the patient was exposed during a family camping trip. Nocardia asteroides is the most frequent cause of nocardial infections in North America. These infections are unusual in healthy individuals, occurring more often in immunologically compromised hosts. They are usually acquired by a pulmonary route and may disseminate widely, most commonly to the central nervous system and skin. Nocardia brasiliensis, when it does occur in the United States, usually causes a chronic cutaneous and subcutaneous infection manifesting itself as mycetoma, abscess, or ulcer. We saw acute suppurative lymphocutaneous Nocardia brasiliensis infection in an otherwise healthy 2-year-old boy.