Future microbiology · 2025
Sporotrichosis or nocardiosis? Case report of subcutaneous tissue infection by Nocardia brasiliensis in an immunocompetent host.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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da Silva Suzane Fernandes, Baesso Umberto Dias, Hipólito João Renato, Neto Junior José Moreira, Bastos André Netto, Watanabe Aripuana Sakurada Aranha, Machado Alessandra Barbosa Ferreira, Diniz Cláudio Galuppo, Da Silva Vania Lucia, Dias Vanessa Cordeiro
Аннотация
BACKGROUND: Nocardia spp. are Gram-positive, acid-fast, aerobic bacteria that typically affect immunocompromised individuals, primarily involving the respiratory tract and central nervous system, though skin dissemination may occur. Cutaneous nocardiosis is rare and often misdiagnosed.
CASE PRESENTATION: We report a case of a 57-year-old Brazilian man, immunocompetent, who presented with a pustular lesion, cellulitis, and ascending lymphangitis on his right leg. His work in plant cultivation and public sanitation suggested environmental exposure. Sporotrichosis was initially suspected, and empirical treatment with itraconazole and cefuroxime was initiated. Bacterial cultures were negative, but fungal cultures revealed an acid-fast organism identified by MALDI-TOF as Nocardia brasiliensis. Treatment was switched to sulfamethoxazole. The patient showed complete lesion resolution within 30 days, without scarring. Therapy was maintained for two additional months, leading to full recovery.
CONCLUSIONS: Cutaneous nocardiosis may mimic other subcutaneous infections like sporotrichosis, delaying accurate diagnosis and appropriate treatment. Clinical suspicion, coupled with laboratory confirmation, is essential for correct management. The use of MALDI-TOF facilitated precise identification of N. brasiliensis, underscoring the importance of specialized microbiological tools. Integrating clinical, epidemiological, and laboratory data is crucial for the diagnosis and successful treatment of rare infections such as lymphocutaneous nocardiosis.
CASE PRESENTATION: We report a case of a 57-year-old Brazilian man, immunocompetent, who presented with a pustular lesion, cellulitis, and ascending lymphangitis on his right leg. His work in plant cultivation and public sanitation suggested environmental exposure. Sporotrichosis was initially suspected, and empirical treatment with itraconazole and cefuroxime was initiated. Bacterial cultures were negative, but fungal cultures revealed an acid-fast organism identified by MALDI-TOF as Nocardia brasiliensis. Treatment was switched to sulfamethoxazole. The patient showed complete lesion resolution within 30 days, without scarring. Therapy was maintained for two additional months, leading to full recovery.
CONCLUSIONS: Cutaneous nocardiosis may mimic other subcutaneous infections like sporotrichosis, delaying accurate diagnosis and appropriate treatment. Clinical suspicion, coupled with laboratory confirmation, is essential for correct management. The use of MALDI-TOF facilitated precise identification of N. brasiliensis, underscoring the importance of specialized microbiological tools. Integrating clinical, epidemiological, and laboratory data is crucial for the diagnosis and successful treatment of rare infections such as lymphocutaneous nocardiosis.