minocycline and Mycetoma

We report two cases of primary cutaneous nocardiosis due to Nocardia otitidiscaviarum. The first case is a mycetoma, the second, a cutaneous abcess: these two cases were imported into France (Vietnam, Zimbabwe). The literature on primary cutaneous nocardiosis due to N. otitidiscaviarum is reviewed.

Topics: Abscess; Adult; Anti-Bacterial Agents; Cephalexin; Cephalosporins; Female; France; Gentamicins; Humans; Male; Middle Aged; Minocycline; Mycetoma; Nocardia; Nocardia Infections; Skin Diseases, Bacterial; Travel; Vietnam; Zimbabwe

An 87-year-old man, a gardener in Okinawa, first noticed a tumor on the dorsum of his right hand in November 2005. He had been taking prednisolone for the treatment of polymyalgia rheumatica since 2000. A nearby dermatologist incised the tumor for pus drainage in February 2006. In April of the same year, the dome-like tumor reappeared. The same treatment was repeated. Because the culture of the pus revealed fungi at that time, terbinafine hydrochloride and minocycline were administrated under the diagnosis of a deep fungal infection. After a short remission, the tumor recurred in November of the same year and in May and August of 2007 regardless of the repeated incision and pus drainage. He was referred to our hospital on 27 September 2007. His first physical examination at our outpatient office showed a skin-colored, well-demarcated, multilocular, cystic subcutaneous tumor on the dorsum of his right hand. Histopathological examination revealed a pseudocyst with fibrous walls of connective tissue. Continuous, bead-like hyphae, positive with periodic acid-Schiff stain and Grocott stain, were found within the pseudocyst. Morphological and molecular biological examinations of the separately cultured specimens identified the causative agent as Exophiala jeanselmei. The entire cyst was removed under local anesthesia, and an artificial dermis made of silicon membrane was applied to the wound. Skin graft was performed in November after confirming no recurrence of the fungal infection. Terbinafine hydrochloride 125 mg/day has continued. No recurrence has been observed up to now.

Topics: Aged, 80 and over; Antifungal Agents; Epidermal Cyst; Exophiala; Giant Cells; Humans; Male; Minocycline; Mycetoma; Naphthalenes; Polymyalgia Rheumatica; Prednisolone; Skin Transplantation; Terbinafine

We report a successfully treated case of mycetoma from which an unusual Nocardia species was isolated. The isolate was identified as N. veterana by biochemical characterization and 16S ribosomal RNA gene sequencing, and it has not been previously reported as a causative agent of human mycetomas. Treatment with various antibiotics over 6 years and surgical resection failed to cure the disease. However, the combination of intravenous imipenem/cilastatin and amikacin along with oral clarithromycin and minocycline proved very effective in this case. This is the first case report of mycetoma due to N. veterana in a clinical setting.

Topics: Adult; Amikacin; Cilastatin; Clarithromycin; Drug Therapy, Combination; Female; Humans; Imipenem; Minocycline; Mycetoma; Nocardia; Occupational Diseases; Treatment Outcome

Two cases of cutaneous nocardial infection are reported. The Nocardia species are gram-positive, partially acid-fast bacteria. Cutaneous involvement may develop as one of four types: (1) mycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection, or (4) systemic disease with cutaneous involvement. A review of each of these types of infection is included, as well as potential clues that may suggest the diagnosis of nocardiosis.

Topics: Abscess; Aged; Amikacin; Drug Combinations; Facial Dermatoses; Humans; Lymphangitis; Male; Minocycline; Mycetoma; Nocardia; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Skin Ulcer; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Foot Dermatoses; Humans; Male; Minocycline; Mycetoma; Tetracyclines