[Primary cutaneous Nocardia farcinica infection following heart transplantation]

A 57-year-old man, treated with immunosuppressive drugs for 3 months after a heart transplantation, developed a painful swelling of the left upper leg and fever. Needle biopsy of the lesion obtained pus from which Nocardia farcinica was cultured. Azathioprine treatment was discontinued and the dosage of cyclosporine reduced. Following antibiotic sensitivity tests, imipenem (4 g/d intravenously) and amikacin (1 g/d intravenously) were administered and the abscess split open. Although the fever responded and dissemination of the infection was excluded the response to treatment was not satisfactory. The drug dosages were repeatedly reduced in response to a rise in serum creatinine concentration to 3.4 mg/dl, deafness, double vision and generalized seizures: the local lesion got worse, but further surgical intervention then brought improvement. After 7 weeks of administration of the above antibiotics, treatment was changed to doxycycline (100 mg/d by mouth). 3 months later computed tomography could no longer demonstrate the lesion.