Soil-acquired cutaneous nocardiosis on the forearm of a healthy male contracted in a swamp in rural eastern Virginia

A 45-year-old man complained of pain and swelling on his right wrist after receiving a scratch while playing paintball in a swampy area of eastern Virginia. Two weeks later, he noticed a pimple-like lesion developing, which quickly grew in size and then ulcerated. Because of the severity of his cond...

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Bibliographic Details
Published inInternational medical case reports journal Vol. 7; no. default; pp. 41 - 47
Main Authors Palmieri, James R, Santo, Arben, Johnson, Shawn E
Format Journal Article
LanguageEnglish
Published New Zealand Dove Medical Press Limited 01.01.2014
Taylor & Francis Ltd
Dove Medical Press
Subjects
Actinomycetales infections
Antibiotics
Blood
Case Report
Case reports
Case studies
Cattle
Disease
Emergency medical care
Identification
Laboratories
Lymphoma
Staphylococcus infections
United States
United States > US
Virginia
trimethoprim-sulfamethoxazole
Nocardia brasiliensis
mycetoma
nocardiosis
actinomycetes
immunocompromised
cutaneous nocardiosis
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Summary:A 45-year-old man complained of pain and swelling on his right wrist after receiving a scratch while playing paintball in a swampy area of eastern Virginia. Two weeks later, he noticed a pimple-like lesion developing, which quickly grew in size and then ulcerated. Because of the severity of his condition, the patient was taken to the emergency room where surgical drainage of the abscess was carried out and the pus was sent for culture and sensitivity testing. Enlarged and tender lymph nodes were palpable going up the arm and surrounding the right axillary area. Three days following culture of pus from his lesion, colonies of Nocardia brasiliensis were isolated. He was successfully treated with an extended regimen of trimethoprim-sulfamethoxazole. Because of its low incidence, nocardiosis is usually not considered in the initial diagnosis. The rapidity with which his infection developed from a pimple-like lesion into an extensive ulcerated area, the involvement of his lymphatic system, the extended time needed to successfully treat his infection, and the potential for infection to rapidly disseminate, reinforces the necessity for laboratory identification and immediate treatment of severe pyogenic cutaneous lesions.
ISSN:1179-142X
1179-142X
DOI:10.2147/IMCRJ.S59315