Abstract
Nocardia spp. are Gram-positive bacteria, which are acid-fast as well. Nocardiosis is characterized by abscess formation anywhere in the body, especially in the lungs, brain, and skin. The disease manifests as pulmonary disease, brain abscess, or disseminated lesions in immunocompromised individuals. However, skin involvement in the form of lymphocutaneous abscess is found in immunocompetent individuals. Nocardia spp. appear as thin, branched filaments in fine needle aspirate under the microscope. Diagnosis of the nocardiosis is done by fine needle aspiration cytology (FNAC) and identification through matrix-assisted laser desorption/ionization-time of flight mass spectrometry from aspirated materials. Our case is lymphocutaneous nocardiosis in a patient having human immunodeficiency (HIV)/tuberculosis coinfection.
Highlights
Categories: Dermatology, HIV/AIDS, Infectious Disease Keywords: branched filaments, lymphocutaneous abscess, nocardiosis, tuberculosis, hiv Nocardia spp. are weak acid-fast and Gram-positive bacteria, which appear as thin branched filaments in fine-needle aspirate smears under the microscope
The annual incidence of Nocardial infection is 0.4 per 100,000 population at various centers and the incidence in HIV patients ranges between 3.4% and 16.7% [1]
Among Nocardia spp., N. brasiliensis is the most common species isolated from a lymphocutaneous disease [2], while there are a few reports of N. nova causing the cutaneous disease [6-7]
Summary
Nocardia spp. are weak acid-fast and Gram-positive bacteria, which appear as thin branched filaments in fine-needle aspirate smears under the microscope. These bacterial infections are neglected especially in tropical countries and are of global concern. Two subcutaneous swellings, which were soft, fluctuant and non-tender, were detected in the left lumbar region (Figure 1B). Culture of pus with growth profile identification using matrix-assisted laser desorption/ionization-time of flight (MALTID-TOF) mass spectrometry showed Nocardia nova. He was treated with co-trimoxazole (25/5 mg/kg body weight) per day in divided doses.
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