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
Pathogen | Age/sex | Subtype | Predisposing factors | Underlying disease | Diagnostic tools | Treatment regimen |
42/F | LC | Traumatic injury | No | Biochemical | TMP/SXT, 6 m | |
64/M | SC | Chemotherapy | Thymoma | 16S rRNA | TMP/SXT+IMP+AMK | |
68/M | SC | Traumatic injury | Cardiomyopathy | 16S rRNA | TMP/SXT, 6 m | |
68/M | SC | Steroid injection | Cushing syndrome | 16S rRNA | TMP/SXT+CRO, 3 m | |
56/M | LC | Prednisolone/chemotherapy | Lung cancer | 16S rRNA | TMP/SXT, 6 m | |
67/M | Mycetoma | Not described | DM | 16S rRNA | CPD, 4 w+Surgery | |
51/M | LC | Immunosuppressive agents | ESRD | 16S rRNA+secA1 | CRO, 9 w & TMP/SXT, 4 m | |
74/F | SC | Unknown | 16S rRNA | CLM 2 w+Cryoth |