CONSTRICTIVE PERICARDITIS AND RECURRENT MYCETOMA DUE TO NOCARDIA-BRASILIENSIS IN NONIMMUNOCOMPROMISED PATIENT

We describe a clinical case of a 35-years-old man who suffered from re current actinomycetoma that started as a single tumefaction nodule on the dorsal area of the left fool in 1981. After three years of unsucce ssful response to the medical treatment, the leg was amputated just be low the knee in 1984. The patient was started on trimethoprim-sulfamet hoxazole Ig daily and itraconazole 250 mg for two years, after this ti me he decided to stop the medication. New nodules and ulcers appeared that spontaneously drained a clear secretion occasionally with a blood y color in the skin adjacent to the knee joint, the lesions extended u p to the lower third of the thigh. Three months before his admission t o the Jose E. Gonzalez University Hospital, he developed progressive d yspnea and cough and a new draining ulcer in the anterior chest wall i n the sternum area. The diagnosis of constrictive peri carditis was ma de and a pericardiectomy was performed. The histopathology study showe d multiple granulomas with acid-fast bacilli. Surprisingly, the etiolo gy was no due to Mycobacterium tuberculosis but to Nocardia brasiliens is. A close relation between antibody concentration and clinical condi tion is found.