ISOLATED CUTANEOUS NOCARDIA-FARCINICA INFECTION 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 abcess of the breast. N. farcinica was identified on puncture specimens and found to be resistant to beta-lactams, aminosides, cyclines, chloram-phenicol, fosfomycin and pefloxacin. No dissemination beyond the skin was observed. The abcess was drained and cleaned surgically and cicatrization was uneventful. Six weeks later the patient was again hospitalized for an inflammatory abcess of the left buttocks which was drained surgically. N. farcinica was again identified and a complete work up eliminated dissemination. Cotrimoxazol was given as a long-term therapy (480 mg trimethoprime, 2.4g sulfamethoxazole) for 6 months and was well tolerated. No recurrence was observed.