Nocardia brasiliensis infection: an emergent suppurative granuloma after mesotherapy

Abstract

A 30-year-old woman presented with a 7-day history of multiple erythematous and purple plaques (1–3 cm in diameter) on her abdomen. She was a postpartum housewife attending a gymnasium where 15 d before she had received subcutaneous mesotherapy with silica, triiodoacetic acid, and artichoke oil to improve her pendulous abdomen. One week after, on the sites of the procedure, she detected painful lesions draining yellowish exudate (Fig. 1). She was treated with dicloxacillin 500 mg every 6 h and diclofenac 100 mg every 12 h for 7 d without improvement. Atypical mycobaterial infection secondary to mesotherapy was suspected; therefore, a biopsy, cultures, and smears were performed. Biopsy showed a suppurative granulomatous dermatitis (Fig. 2), but no microorganisms were visualized with Ziehl–Neelsen, Gomori–Grocott, or periodic acid-Schiff stains. Nocardia spp., was isolated on Sabouraud dextrose agar (Fig. 3) and N. brasiliensis was identified by molecular biology. Molecular identification was carried out by sequencing 16S rRNA. Genomic DNA was isolated using a DNeasy blood and tissue kit (Qiagen, Ventura, CA, USA) according to the manufacturer’s instructions. The polymerase chain reaction product was purified using a QIAquick PCR Purification Kit (Qiagen, La Jolla, CA, USA) as recommended by the suppliers. Nucleotide sequence was determined in both directions with Taq FS Dye Terminator Cycle Sequencing Fluorescence-Based Sequencing and analyzed on a Perkin Elmer/Applied Biosystems (Foster City, CA, USA) 3730 DNA sequencing system. The sequences showed 100% identity with N. brasiliensis CDC :W7503. The complete sequence obtained 888 Figure 1 Multiple erythematous and purple plaques, 1–5 cm of diameter