ISOLATED CUTANEOUS NOCARDIA-FARCINICA INF ECTION IN AN IMMUNODEPRESSED PATIENT

Nocardiosis is a rare localized or systemic infection caused by bacter ia of the Actinomycetaceae family. Nocardia farcinica, recently identi fied as a distinct species from Nocardia asteroides, characteristicall y causes severe systemic infections and is particularly resistant to a ntibiotics. We report a case of nocardiosis observed in a patient rece iving general corticosteroid therapy for bullous pemphigoid and,who de veloped a sub cutaneous abcess of the breast. N. farcinica was identif ied on puncture specimens and found to be resistant to beta-lactams, a minosides, cyclines, chloram-phenicol, fosfomycin and pefloxacin. No d issemination beyond the skin was observed. The abcess was drained and cleaned surgically and cicatrization was uneventful. Six weeks later t he patient was again hospitalized for an inflammatory abcess of the le ft buttocks which was drained surgically. N. farcinica was again ident ified and a complete work up eliminated dissemination. Cotrimoxazol wa s given as a long-term therapy (480 mg trimethoprime, 2.4g sulfamethox azole) for 6 months and was well tolerated. No recurrence was observed .