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Microbes & Immunity

CASE REPORT
Primary cutaneous nocardiosis due to Nocardia

farcinica in an immunocompetent patient:
A case report

Maya Polashenski* and Olga Vasylyeva

Department of Infectious Disease, Rochester General Hospital, 1425 Portland Ave, Rochester,
New York, United States of America

Abstract

Nocardia is an opportunistic pathogen that can present as pulmonary, central nervous
system, or disseminated infection in immunocompromised host. However, primary
cutaneous Nocardia infections have distinctive presentations in immunocompetent
hosts. When infecting a host with an intact immune system, the infection tends to
be more insidious, delaying accurate diagnosis and leading to inadequate treatment
and persistent infection. Herein, we present a rare case of post-operative cutaneous
nocardiosis in a 57-year-old immunocompetent patient with a delay in therapy
resulting in a prolonged non-healing wound. Nineteen case reports were reviewed
to identify trends in immune status, exposure, treatment regimens, and responses
to therapy in both immunocompromised and immunocompetent patients with
*Corresponding author: Nocardia farcinica cutaneous infection. This case report summarizes characteristics
Maya Polashenski
(maya.polashenski@ of patient populations where N. farcinica might be suspected and emphasizes the
rochesterregional.org) importance of a thorough environmental and occupational history in the case
Citation: Polashenski M, of immunocompetent patients. It also addresses challenges in the treatment of
Vasylyeva O. Primary cutaneous cutaneous N. farcinica as related to empiric therapy, antibiotic resistance, and duration
nocardiosis due to Nocardia of treatment, ultimately providing an algorithm to approach the management of
farcinica in an immunocompetent
patient: A case report. Microbes & primary cutaneous nocardiosis.
Immunity. 2025;2(4):144-149.
doi: 10.36922/mi.5189
Keywords: Postoperative infection; Actinomycete; Nocardiosis; Nocardia farcinica;
Received: October 17, 2024 Primary cutaneous nocardiosis
Revised: November 30, 2024
Accepted: December 9, 2024
Published online: December 31, 1. Introduction
2024
Nocardia is a genus of bacteria that is an uncommon pathogen. It is better known as an
Copyright: © 2024 Author(s).
This is an Open-Access article opportunistic pathogen causing infection in lungs, central nervous system (CNS), or
distributed under the terms of the disseminated infection in an immunocompromised host. However, primary cutaneous
Creative Commons Attribution Nocardia infections are unique in involving immunocompetent hosts. When infecting a
License, permitting distribution,
and reproduction in any medium, host with an intact immune system, the infection tends to be more insidious, which risks
provided the original work is impeding a timely diagnosis, leading to inadequate treatment and persistent infection.
properly cited. Nocardia species are able to survive in a host due to their ability to evade innate and
1
Publisher’s Note: AccScience cellular immune responses. One way this is achieved is by resisting phagocytosis
Publishing remains neutral with and even neutralizing destruction through oxidative killing mechanisms, which are
regard to jurisdictional claims in 1
published maps and institutional accomplished by certain bacterial enzymes. In addition, Nocardia species belongs to
1
affiliations. the optional intracellular organisms, with the ability to evade immune surveillance.
Volume 2 Issue 4 (2025) 144 doi: 10.36922/mi.5189