Abstract
Introduction: Reports of paediatric cases of primary cutaneous nocardiosis are rare in Japan. We report the case of a 5-year-old immunocompetent boy with primary cutaneous nocardiosis. Case presentation: One week after injuring his left knee, the boy presented with fever, pain in the left hip joint and gait disturbance. Oral administration of cephalosporin proved ineffective, and he was not able to stand due to pain in the inguinal region. On admission, swelling of the left inguinal lymph nodes and abscess with microsatellite pustules in the left knee were found. Gram-positive bacilli with branching filaments grew in the culture from the drained pustule. They were partially acid fast on Ziehl–Neelsen staining. His symptoms improved after initiating treatment with sulbactam/cefoperazon and sulfamethoxazole/trimethoprim (TMP-SMX). Nocardia brasiliensis was identified from 16S rRNA gene sequencing. TMP-SMX was administered for 5 weeks, and no relapses have occurred as of the 1-year follow-up. Conclusion: N. brasiliensis lives in soil and is the major cause of primary lymphocutaneous nocardiosis. A cutaneous abscess with surrounding microsatellite lesions and lymphadenopathy suggest the possibility of cutaneous nocardiosis. Because growth of Nocardia spp. is very slow, adequate incubation time is necessary.
Highlights
Reports of paediatric cases of primary cutaneous nocardiosis are rare in Japan
Pulmonary nocardiosis is the most common clinical presentation, because inhalation is the primary route of bacterial exposure, and this infection may spread to any area of the body
Brain abscess is seen in 15–40 % of pulmonary nocardiosis cases (Jacobs & Schutze, 2011)
Summary
Most nocardial infections (nocardiosis) occur in immunosuppressed and immunodeficiency individuals (Biscione et al, 2005; Roberts et al, 2000; Santos et al, 2002; Torres et al, 2002). A 5-year-old Japanese boy was admitted to our hospital with a 5-day history of hip joint pain, gait disturbance and high-grade fever His past and family histories were unremarkable. Erythematous swelling of the left knee was noted, accompanied by white maceration and erosions with shallow ulcers and satellite pustules (Fig. 1a) Another blood examination showed the following: white blood cell count of. On hospital day 2, the pustules on the left knee were drained and irrigated with normal saline His fever subsided to 37.4 uC, but pain in the left inguinal region continued and the serum CRP level showed no significant change. Oral sulfamethoxazole-trimethoprim (TMP-SMX) and intravenous sulbactam-cefoperazone (SBT/CPZ) were started on hospital day 4 His fever subsequently subsided, the left hip joint pain disappeared and the pustules on his left knee improved. The cultures from the patient showed susceptibility to both TMP-SMX and SBT/CPZ in an antibiogram test using disk diffusion
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