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Case Reports
. 2021 May 25;14(5):e241217.
doi: 10.1136/bcr-2020-241217.

Primary cutaneous nocardiosis of the head and neck in an immunocompetent patient

Claudio Tirso Acevedo  1 , Frank Imkamp  2 , Ewerton Marques Maggio  3 , Silvio Daniel Brugger  4
Affiliations
Case Reports

Primary cutaneous nocardiosis of the head and neck in an immunocompetent patient

Claudio Tirso Acevedo et al. BMJ Case Rep. .

Abstract

Nocardiosis is known to be an opportunistic infection most commonly affecting immunocompromised patients that can lead to life-threatening conditions. Primary cutaneous disease remains a rare manifestation and unlike pulmonary or disseminated nocardiosis, it usually affects immunocompetent individuals. We present a case of a primary cutaneous nocardiosis of the head and neck after an insect bite in a healthy 50-year-old woman who had recently travelled from Greece. She presented with a painful right-sided swelling of her face and neck and an ulcerated plaque over the right temple. Biopsy of the plaque revealed inflammation with abscess formation indicating underlying infection. Culture from the biopsy showed growth of Nocardia spp and 16S rRNA gene sequence analysis identified Nocardia brasiliensis The patient was treated with trimethoprim/sulfamethoxazole and subsequently switched to amoxicillin/clavulanic acid due to a drug eruption. Antibiotic therapy was continued for a total of 3 months with complete resolution of the skin lesions.

Keywords: dermatology; infectious diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) and (B) Initial presentation with right-sided swelling of the face and an ulcerated plaque at the temple. (C) Two weeks after initial admission.
Figure 2
Figure 2
(A) and (B) Contrast-enhanced CT scan showing diffuse reticulation of subcutaneous fat in the area of the right cheek and temple with subcutaneous and superficial soft-tissue swelling reaching the periorbital and preauricular region.
Figure 3
Figure 3
Histopathology of the skin biopsy using Brown Brenn staining shows a thin and filamentous structure consistent with Nocardia spp.
See this image and copyright information in PMC

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