Abstract and Introduction
We report the case of a 61-year-old female with ulcerative colitis on therapy with prednisone and azathioprine. The patient presented with fever, dry cough, a swollen lower extremity, and nodules on the right wrist and the scalp. Computed tomography scans of the head, chest, abdomen, and pelvis revealed multiple lesions. Aspirates and biopsies of the lower extremity cystic lesion, the wrist nodule, and the scalp nodule all grew out Nocardia nova. The patient was treated with high-dose trimethoprim and sulfamethoxazole therapy for one year and made a complete recovery.
Nocardia are fastidious aerobic actinomycetes species that are inhabitants of the soil.[1,2] Nocardiosis is a rare disease which most commonly affects immunocompromised patients.[2,3] Infection is acquired by two main routes: pulmonary infection due to inhalation of the organism from dust or soil, and cutaneous invasion due to direct inoculation from minor trauma.[4,5] Disseminated nocardiosis, which is defined by Nocardia being isolated from two or more noncontiguous locations within the body, usually begins as a pulmonary infection.Nocardia has an aggressive nature, and has a high mortality rate if left untreated. The brain is the most frequent nonpulmonary site involved in disseminated nocardiosis. Central nervous system (CNS) involvement with disseminated nocardiosis results in up to a 55% mortality rate in immunocompromised patients. Treatment for disseminated Nocardia depends upon the presence or absence of CNS involvement and/or multiple organ involvement.[6,7]
South Med J. 2010;103(12):1269-1271. © 2010 Lippincott Williams & Wilkins
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