Subcutaneous Nocardia asteroides abscess in a bone marrow transplant recipient

We describe a case of cutaneous Nocardia asteroides infection in a 13-year-old Venezuelan boy with aplastic anemia, following allogeneic BMT. He was receiving immunosuppressive therapy with corticosteroids for GVHD and trimethoprim/sulfamethoxazole (TMP/SMX) for prophylaxis against Pneumocystis carinii pneumonia (PCP). He was not neutropenic and gave no history of cutaneous inoculation or trauma. He developed an abscess on the plantar surface of his right big toe from which Nocardia asteroides was isolated. He was successfully treated with a combination of TMP/SMX and minocycline. Despite prolonged immunosuppressive therapy for GVHD, the infection responded and did not recur. TMP/SMX prophylaxis for PCP in BMT recipients with GVHD does not always prevent nocardial infection but may prevent or delay the development of dissemination.