Nocardiosis ‘great imitator’: unusual disease with usual presentations at unusual site

Abstract

Nocardia, an aerobic actinomycete, typically affects immunosuppressed individuals, commonly manifesting in the lungs. Cutaneous infections, particularly by N. pseudobrasiliensis, can occur, presenting as lympho-cutaneous, superficial, or mycetoma subtypes. Nocardia farcinica, resistant to third-generation cephalosporins, is particularly virulent. A 50-year-old female with type 2 diabetes presented with painful nodules, bullae, and recurrent discharge over the left wrist, mimicking cellulitis. Culture-sensitivity revealed Nocardia farcinica. Treatment involved debridement, De quervain release and prolonged Linezolid therapy for a complete cure. Cutaneous Nocardiosis can mimic cellulitis, posing diagnostic challenges due to slow growth and microbiological detection. N. farcinica demonstrated resistance to conventional antibiotics. This case emphasizes the importance of considering Nocardia infections in diverse clinical presentations, highlighting the need for a comprehensive diagnostic approach, especially in immunocompromised individuals.