trimethoprim--sulfamethoxazole-drug-combination and Polymyositis

We report a lymphocutaneous type of nocardiosis caused by Nocardia vinacea. A 62-year-old woman with polymyositis presented with some erythematous swellings and subcutaneous abscesses on her right middle finger and the dorsum of her hand, which had persisted for 2 weeks. Culturing of the excised nodule and pus revealed orange to orange-tan colonies with scanty whitish aerial mycelia. The isolate was identified as N. vinacea on the basis of its biochemical and chemotaxonomic characteristics and the results of molecular biological analysis. In our case, oral minocycline (MINO) and trimethoprim-sulfamethoxazole (TMP-SMX) for 7 weeks did not improve the clinical manifestation, even though in vitro susceptibility testing of the isolate predicted its susceptibility to MINO and TMP-SMX. Treatment with partial surgical excision followed by TMP-SMX and meropenem administration was effective. This is the first reported case of a lymphocutaneous type of nocardiosis caused by N. vinacea.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Debridement; DNA, Bacterial; DNA, Ribosomal; Female; Humans; Meropenem; Minocycline; Nocardia; Nocardia Infections; Polymyositis; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Skin Diseases, Bacterial; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Two female cases of primary cutaneous nocardiosis due to Nocardia brasiliensis are described. The first was associated with polymyositis and the second with chronic immune thrombocytopenic purpura. Both patients had received corticosteroids. In both cases the responsible actinomycetes were sensitive to trimethoprim/sulfamethoxazole. This drug was administered to both patients with excellent results. Treatment was continued for 3 months to prevent recurrence, a common consequence of short-term therapy. N. brasiliensis should be included in the differential diagnosis of any case of nodular lymphangitis, especially in immunocompromized patients.

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Methotrexate; Middle Aged; Nocardia Infections; Polymyositis; Prednisolone; Prednisone; Purpura, Thrombocytopenic; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination