Treatment of a Nocardia brasiliensis Mycetoma With Sulfamethoxazole and Trimethoprim, Amikacin, and Amoxicillin and Clavulanate

Abstract

REPORT OF A CASE A 29-year-old Mexican man who had lived in the United States for 15 years was referred to the dermatology clinic at the Los Angeles County/University of Southern California Medical Center, Los Angeles, for evaluation of a possible mycetoma of the right foot. The disorder had started 8 years before, when the patient injured his foot with a blunt metal object at work. Subsequently, multiple sinus tracts draining blood and pus had formed on the foot. Empiric treatment with combinations of dapsone, rifampin and isoniazid, sulfamethoxazole and trimethoprim, gentamicin, ampicillin, tetracycline, and intralesional triamcinolone acetonide suspension had been unsuccessful. The patient had no relevant medical history, no allergies to medications, and used tobacco and alcohol occasionally. On physical examination, the right foot and ankle were firm, swollen, and in fixed plantar flexion. Multiple crusted, friable nodules and sinus tracts draining serosanguinous and purulent material were seen (Fig