Pulmonary nocardiosis with cutaneous involvement mimicking a metastasizinglung carcinoma in a patient with chronic myelogenous leukaemia

We report a unique case of a man suffering from chronic myelogenous leukaem ia who presented with clinical symptoms, X-ray, and bronchoscopical finding s consistant with a bronchopulmonary space-occupying process which was susp ected to be a central lung carcinoma as a secondary de novo malignancy. In addition, the patient developed several subcutaneous nodular livid red lesi ons on the left forearm which were considered to be cutaneous metastases of the presumptive lung malignancy. Treatment was started with percutaneous r adiation of the mediastinum over a period of ten days with a total dose of 25 Gray. The patient died from circulatory and respiratory failure. Only po st mortem pathological examination was indicative of a nocardiosis of the l ungs with haematological spread to eosophagus, pleura, and subcutaneous ski n of the left forearm. Unfortunately, diagnosis of nocardiosis could not fi nally proven by culture or molecular biological methods. A lung carcinoma o r an infiltrate of residual or relapsing chronic myelogenous leukemia in th e lung could be definitely ruled out.