Linfoadenitis necrotizante por Nocardia asteroides en una niña previamente sana / [Necrotizing lymphadenitis caused by Nocardia asteroides in a healthy girl]

RESUMO

A case of a healthy girl with a trauma in her right leg is described. Twelve hours later she developed fever and pain in the inguinal region. Two days later, she was admitted to the Hospital, and there, an aspiration of pus from the lymph node was performed, and this sample was sent for culture. The Gram smear showed gram-positive filamentous bacilli and when Kinyoun was used they were observed as weakly acid fast rods. After four days of incubation under aerobic conditions, white and hemolitic colonies were seen on human blood agar plates. Biochemical tests as urea hydrolysis and gelatin liquefaction were performed. To complete the identification it was sent to a reference laboratory, INEI-ANLIS Dr. Carlos G. Malbrán, where the isolate was confirmed as Nocardia asteroides sensu stricto. The patient was treated with intravenous cephalotin with good evolution. Therapy was followed with oral trimethoprim-sulfamethoxazole. This case is the first report of a Nocardia infection in the Hospital de Niños de Santa Fe. The fact that N. asteroides was isolated from an immunologically competent girl should be highlighted. This species is uncommon in children and it is rare in our region. In addition, N. asteroides infections are usually seen in pulmonary disease and rarely producing cutaneous infections.