Nocardia abscessus Cutaneous Abscess:A Case Report and Review of the Literature

희수 박1   보라 손1   민숙 손3   경섭 신*2   

1 Department of Laboratory Medicine, Chungbuk National University Hospital
2 Departments of Laboratory Medicine
3 Microbiology Chungbuk National University College of Medicine, Cheongju

Abstract

We describe a cutaneous abscess caused by Nocardia abscessus in a previously healthy woman. A 74- year-old woman presented with recurrent bullae on her left forearm that developed 1 week prior and was initially suspected to be a cutaneous infection with Mycobacteria or Tinea corporis. Histopathologically, the skin lesion formed an abscess. A smear revealed a few branched Gram-positive filamentous microorganisms that formed a creamy white colony on a blood agar plate after incubation for 3 days. The colony tested negative on acid-fast bacilli (AFB) staining, but was positive on modified AFB staining. The isolate was confirmed to be N. abscessus by 16S rRNA sequencing analysis. The isolate was susceptible to trimethoprim-sulfamethoxazole, amikacin, cefotaxime and erythromycin but resistant to penicillin. The patient was treated with clarithromycin but subsequently lost to follow-up. To the best of our knowledge, this is the first report of a human cutaneous infection with N. abscessus in Korea. (Ann Clin Microbiol 2018;21:64-67)

Keywords

Cutaneous abscess   Nocardia abscessus   16S rRNA sequence   


Figures & Tables

Fig. 1. Phylogenetic tree of the current isolate (CBU 05/1969: 1,362 bp) and Nocardia species. The 16S rRNA gene sequences of Nocardia species available in GenBank were aligned using CLUSTAL V and the phylogenetic tree was generated by the neighbor-joining method. Bootstrap values (%) are shown near their corresponding branches; ‘0.1’ indicates 0.1 nucleotide substitutions per site.


Figures & Tables

Table 1. Clinical characteristics and diagnostic tools for the patients with primary cutaneous Nocardiosis in Korea

PathogenAge/sexSubtypePredisposing factorsUnderlying diseaseDiagnostic toolsTreatment regimen
N. asteroides [8]42/FLCTraumatic injuryNoBiochemicalTMP/SXT, 6 m
N. brasiliensis [9]64/MSCChemotherapyThymoma16S rRNATMP/SXT+IMP+AMK
N. brasiliensis [10]68/MSCTraumatic injuryCardiomyopathy16S rRNATMP/SXT, 6 m
N. brasiliensis [11]68/MSCSteroid injectionCushing syndrome16S rRNATMP/SXT+CRO, 3 m
N. brasiliensis [12]56/MLCPrednisolone/chemotherapyLung cancer16S rRNATMP/SXT, 6 m
N. farcinica [13]67/MMycetomaNot describedDM16S rRNACPD, 4 w+Surgery
N. nova [14]51/MLCImmunosuppressive agentsESRD16S rRNA+secA1CRO, 9 w & TMP/SXT, 4 m
N. abscessus*74/FSCUnknown16S rRNACLM 2 w+Cryoth