[Nocardia farcinica infection. Cutaneous form in an immunodepressed patient]

Nocardiosis is a rare localized or systemic infection caused by bacteria of the Actinomycetaceae family. Nocardia farcinica, recently identified as a distinct species from Nocardia asteroides, characteristically causes severe systemic infections and is particularly resistant to antibiotics. We report a case of nocardiosis observed in a patient receiving general corticosteroid therapy for bullous pemphigoid and who developed a sub-cutaneous abscess of the breast. N. farcinica was identified on puncture specimens and found to be resistant to beta-lactams, aminosides, cyclines, chloramphenicol, fosfomycin and pefloxacin. No dissemination beyond the skin was observed. The abscess was drained and cleaned surgically and cicatrization was uneventful. Six weeks later the patient was again hospitalized for an inflammatory abscess of the left buttocks which was drained surgically. N. farcinica was again identified and a complete work-up eliminated dissemination. Cotrimoxazole was given as a long-term therapy (480 mg trimethoprim, 2.4g sulfamethoxazole) for 6 months and was well tolerated. No recurrence was observed.