Isolated nocardiasis presenting as a huge cold abscess: a case report and review of literature

ABSTRACT

Nocardia, a gram positive higher bacterium, presents usually as pulmonary disease or mycetoma, or rarely as metastatic lesion from lung, or as a primary isolated lesion in skin, subcutaneous tissues, lymphatics, eyes, central nervous system. etc. We report a case, a 50 years old male diabetic, who presented with a rare manifestation of Nocardiasis in the form of an isolated gluteal abscess involving subcutaneous tissue and intermuscular planes that was drained successfully and diagnosis confirmed on culture of pus. Isolated nocardial lesions, a rarity, are seen in immunocompromised host. Our patient, the first of its kind reported from Al Dhahira region of Oman, had only diabetes mellitus [DM] as associated illness and did not have any identifiable source of infection. Diabetes may have caused some compromise in immunity; otherwise he did not have HIV infection or any other cause for depressed immunity. Nocardiasis should be suspected in immunocompromised patients with peculiar mass lesion, strange neurologic presentation and isolated lesions such as gluteal abscess, as in our patient