Document Detail


Actinomycetoma of the chest wall attributed to Nocardia nova after reconstructive surgery.
MedLine Citation:
PMID:  22301041     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
A 29-year-old man, presented with multiple ulcers, nodules, abscesses, fistulae, and atrophic scars, over the right chest wall. Six years prior, the patient had a car accident, which resulted in skin loss of the right arm, shoulder, thoracic wall. In addition, he suffered a supracondylar fracture; orthopedic surgery and skin grafts were required. Material discharging from sinus tracts was obtained for mycological and bacteriological studies. Direct microscopic examination revealed small white grains. Cultures on Sabouraud and Lowenstein-Jensen media isolated orange-white colonies suggestive of Nocardia. PCR assay identified Nocardia nova. Thoracic and right upper limb CT showed signs of chronic osteomyelitis. Treatment with imipenem/cilastatin for 8 weeks, followed by amoxicillin clavulanate for 6 months, resulted in healing of lesions and improvement in the patient's general health. Primary cutaneous nocardiosis remains a diagnostic challenge. Nocardia are soil-borne filamentous gram-positive bacteria. Identification of characteristic granules on examination of discharge smears from discharge or tissue biopsy is essential for diagnosing mycetoma. Because grain discharge is discontinuous, multiple clinical specimens should be submitted for microscopic examination and culture. Sulfonamides have been the mainstay of Nocardia actinomycetoma treatment. However, our patient's strain was resistant to Co-trimoxazole. Therefore, treatment with imipenem followed by amoxicillin clavulanate was favored, with good clinical and analytical response.
Authors:
Joana Antunes; David Pacheco; Rita Travassos; Hortênsia Sequeira; Paulo Filipe; Manuel Sacramento Marques
Publication Detail:
Type:  Journal Article     Date:  2012-01-15
Journal Detail:
Title:  Dermatology online journal     Volume:  18     ISSN:  1087-2108     ISO Abbreviation:  Dermatol. Online J.     Publication Date:  2012  
Date Detail:
Created Date:  2012-02-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9610776     Medline TA:  Dermatol Online J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4     Citation Subset:  IM    
Affiliation:
Serviço de Dermatologia, Hospital de Santa Maria, Lisboa, Portugal.
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