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Microbes & Immunity A case of cutaneous Nocardia farcinica

several antibiotics, including most beta-lactam antibiotics Conflict of interest
(notably ampicillin and third-generation cephalosporins),
clarithromycin and most aminoglycosides. 23,24 Research The authors declare that they have no competing interests.
on the genomic sequence of N. farcinica demonstrated a Author contributions
chromosome containing plasmids and genes responsible
for this intrinsic multidrug resistance. Cephalosporins are Conceptualization: Maya Polashenski
24
the first-line empiric therapy for many skin and soft tissue Investigation: Maya Polashenski
infections, which can cause challenges in choosing empiric Writing – original draft: Maya Polashenski
antibiotics for patients who have primary cutaneous Writing – review & editing: Olga Vasylyeva
nocardiosis. This is especially true in immunocompetent
patients when more common bacterial causes will Ethics approval and consent to participate
often be the leading differential diagnosis. In the case Informed consent was verbally obtained to write up the
described above, the patient was prescribed four courses patient’s case and use the photograph of her hand.
of cephalosporins despite identification of N. farcinica on
aerobic culture early on. This was compounded by the Consent for publication
slow growing nature of the pathogen, since sensitivities Verbal informed consent was obtained prior to submitting
were not released for 2 months after the initial culture this manuscript for publication.
grew. This highlights the importance of early consultation
for antibiotic recommendations from infectious disease Availability of data
specialists in cases of Nocardia infections.
Data are available from the corresponding author on
The limitations of this case report include lack of reasonable request.
dedicated infectious disease follow-up, and no photo-
based evidence of cure since the patient was noted to have References
resolution of her wound at another specialist’s appointment. 1. Fatahi-Bafghi M. Nocardiosis from 1888 to 2017. Microb
In addition, there is limited documentation available Pathog. 2018;114:369-384.
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and cyst removal on flexor tendon, as well as the outpatient
incision and drainage itself, as it was completed at a facility 2. Gao S, Liu Q, Zhou X, Dai X, He H. Primary cutaneous
where our electronic health record is not synchronized. nocardiosis due to Nocardia farcinica: A case report of an often
overlooked infection. Infect Drug Resist. 2021;14:1435-1440.
4. Conclusion doi: 10.2147/IDR.S306161

We presented a case of an immunocompetent patient 3. Wilson JW. Nocardiosis: Updates and clinical overview.
who had a non-healing surgical wound after a camping Mayo Clin Proc. 2012;87(4):403-407.
trip where she used well water, despite multiple surgical doi: 10.1016/j.mayocp.2011.11.016
interventions and months of empiric antibiotic treatment
using cephalosporins. Her wound cultures grew N. farcinica 4. Rawat D, Rajasurya V, Chakraborty RK, Sharma S.
Nocardiosis. In: StatPearls. Treasure Island, FL: StatPearls
repeatedly. Literature review shows that N. farcinica Publishing; 2023.
in immunocompetent patients is often preceded by
environmental exposure and requires prolonged treatment 5. Hemmersbach-Miller M, Stout JE, Woodworth MH,
with specific antibiotics, with first-line therapy being TMP- Cox GM, Saullo JL. Nocardia infections in the transplanted
SMX to resolve the infection. It is important to involve host. Transpl Infect Dis. 2018;20(4):e12902.
infectious disease specialists as early as possible when doi: 10.1111/tid.12902
primary cutaneous nocardiosis is diagnosed to expedite 6. Merinopoulos D, Khan H, Ginwalla S, Lane S, Watts R.
treatment with proper antibiotics and shorten the duration Nocardia farcinica complicating Cogan’s syndrome. Oxf Med
of therapy. Case Reports. 2014;2014(2):36-38.

Acknowledgments doi: 10.1093/omcr/omu016
7. Auzary C, Mouthon L, Soilleux M, Cohen P, Boiron P,
None.
Guillevin L. Localized subcutaneous Nocardia farcinica
Funding abscess in a woman with overlap syndrome between
systemic scleroderma and polymyositis. Ann Med Interne
None. (Paris). 1999;150(7):582-584.

Volume 2 Issue 4 (2025) 148 doi: 10.36922/mi.5189