Primary Lymphocutaneous Nocardia brasiliensis in an Immunocompetent Host: Case Report and Literature Review.

Nocardia spp. is a Gram-positive, partially acid-fast aerobic bacterium usually associated with infection in immunocompromised people. The most common sites of infection are the skin, lungs, and the brain, however disease can disseminate and affect every organ. Clinical manifestations of cutaneous disease are varied and frequently misdiagnosed. We present a case of an immunocompetent 66-year-old man who sustained a left finger injury while gardening. He was misdiagnosed on several occasions and treated with inappropriate antibiotics against Streptococcus spp. and Staphylococcus spp. When infection spread cutaneously, sporotrichoid (lymphocutaneous) nocardiosis was suspected and the patient was started on appropriate therapy with Bactrim which resulted in a cure. We also summarize the literature on lymphocutaneous infection by Nocardia brasiliensis. By reporting this case, we want to raise awareness among clinicians about unusual causes of cellulitis, the differential diagnosis of lymphocutaneous infection and the importance of obtaining a detailed exposure history to assist in the prompt diagnosis of nocardiosis.

Trichosporon asahii Infection in a Patient with Metastatic Prostate Cancer as an Example of an Emerging Fungal Pathogen.

CLINICAL HISTORY PATIENT: 59-year-old white man. CHIEF COMPLAINT: Nausea, constant urge to urinate, and intermittent lower back pain that wraps around his right iliac crest and down his right anterior thigh to the level of his right knee. HISTORY OF PRESENT ILLNESS: The patient sought radiation oncology consultation for his metastatic prostate cancer. He has had nephrostomy tubes and ureteral stents implanted to help with his bilateral uropathic manifestations. Two days earlier, his ureteral stent was removed and sent for culture during the replacement of his malfunctioning nephrostomy tubes; Trichosporon asahii had been cultured from the stent. PREVIOUS MEDICAL HISTORY: Castration-resistant prostate cancer with bone metastasis, left upper abdominal shingles, recurrent urinary tract infections (UTIs), chronic anemia due to chemotherapy, and obstructive bilateral uropathy. FAMILY HISTORY: Mother had breast cancer and father had lung cancer and heart disease. PHYSICAL EXAMINATION FINDINGS: The patient was alert and oriented. There was a small, soft, compressible nodule, or cyst, in the posterior supraclavicular region. His lungs were clear, and his pulse had a regular rate and rhythm. PRINCIPLE LABORATORY FINDINGS: Table 1.