Chronic renal insufficiency complicated by skin infection with Nocardia brasiliensis: A case report.

BACKGROUND: Nocardiosis is a rare bacterial infection with unclear epidemiology, pathogenesis, and characteristics. Its clinical manifestations are diverse and nonspecific, making diagnosis prone to errors, including misdiagnosis and missed diagnosis. Additionally, this disease is difficult to treat, often requiring months or even years of antibacterial therapy, and can be fatal in patients with underlying conditions.

CASE SUMMARY: A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb. As a result of an initial misdiagnosis and inadequate treatment, the infection progressed, resulting in multiple rashes on his right upper limb. Local incision and drainage of pus, combined with oral antibiotics administered at a different hospital, yielded no significant improvement. Upon hospitalization, the patient's immune function was assessed, and further local incision and drainage were performed. Cultures of the pus identified Nocardia brasiliensis. Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim, leading to the patient's recovery. After discharge, the patient continued to take sulfamethoxazole tablets for 6 months, with complete healing of the skin lesions and no recurrence.

CONCLUSION: Nocardiosis should be considered in patients with underlying conditions and compromised immunity. Prompt and accurate diagnosis is crucial.