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Case Reports
. 2023 Jan 13:16:263-268.
doi: 10.2147/IDR.S395333. eCollection 2023.

A Rare Case of a Subcutaneous Abscess Caused by Nocardia cyriacigeorgica in an Immunocompetent Patient

Huoyang Lv #  1 , Mengyuan Chen #  1   2 , Youqi Ji #  1   3 , Liya Pan  4 , Xin Hong  1   5 , Yumei Ge  1   2   3   4   5   6
Affiliations
Case Reports

A Rare Case of a Subcutaneous Abscess Caused by Nocardia cyriacigeorgica in an Immunocompetent Patient

Huoyang Lv et al. Infect Drug Resist. .

Abstract

Background: Nocardia cyriacigeorgica, which mainly causes pleuropulmonary and disseminated nocardiosis, has been proved to be one of the most common opportunistic pathogens in patients with immunodeficiency, but the cases that cause subcutaneous abscesses in normal individuals are rare and should be paid attention to.

Methods: The clinical data of a patient with cutaneous nocardiosis caused by Nocardia cyriacigeorgica in Zhejiang Provincial People's Hospital were retrospectively analyzed, including clinical manifestations, laboratory examinations, imaging examinations, medication and prognosis.

Results: Magnetic resonance imaging (MRI) showed that there was a 26 mm × 73 mm abscess under the skin. The pus in the abscess was green. Gram staining showed positive branched rod-shaped and undivided hyphae. After culture, small wrinkle dry white small colonies were observed, and it was identified as Nocardia cyriacigeorgica by MALDI-TOF MS.

Conclusion: We report the first case of a subcutaneous abscess caused by Nocardia cyriacigeorgica in an immunocompetent patient. Compared with cutaneous nocardiosis of which approximately 80% caused by Nocardia brasiliensis invasion, infection of Nocardia cyriacigeorgica is more insidious and latent, the features of the lesions are also unique. For this Nocardia cyriacigeorgica clinical isolate, the tested antibacterial drugs are generally sensitive and have an ideal prognosis after treatment with linezolid and timely debridement.

Keywords: MALDI-TOF MS; Nocardia cyriacigeorgica; debridement; matrix-assisted laser desorption ionization-time-of-flight mass spectrometry; nocardiosis; subcutaneous abscess.

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Conflict of interest statement

The authors declare that they have no competing interests in this work.

Figures

Figure 1
Figure 1
Imaging examination. (A) Magnetic resonance imaging (MRI) of vertebra lumbalis showed a 26 mm × 73 mm subcutaneous abscess with low signal intensity on T1WI and high signal intensity on T2WI (arrows). (B) The chest radiograph showed that the patient’s lungs were normal.
Figure 2
Figure 2
Pathogenic examination. (A) Gram-positive and branching rod-shaped bacterium was observed by Gram staining under oil mirror (×1000 magnification). (B) Acid fast staining showed weak positive mycelia, which proved that it was probably Nocardia spp. (C) Wrinkled, dry and white colonies of different sizes were observed by culture on the blood plate. (D) Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) confirm it was Nocardia cyriacigeorgica.
See this image and copyright information in PMC

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