Back issues No.3 - 1997 / Case Report  

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Lymphocutaneous Nocardiosis
Yi-Hua Liao, Tsen-Fang Tsai, Chun-Hsiang Chang
Dermatol Sinica 15: 162-168, 1997

Two unusual cases of primary lymphocutaneous nocardiosis presenting as a primary inoculation ulcer and ascending nodular lymphangitis are herein reported. Fever and regional lymphadenopaty were also noted. One patient had a definite inoculation history by an abrasion wound that occurred three weeks prior to the development of the skin lesions. Histological examination of the subcutaneous nodules showed neutrophilic infiltration in the lower dermis and subcutaneous layer. Grams stain and modified acid-fast stain of draining pus and skin biopsies showed gram-positive and partially acid-fast branching filaments, respectively. Nocardia brasiliensis was isolated from the draining pus and skin biopsies of both cases. Patient 1 responded well to oral co-trimoxazole treatment and patient 2 ren a self-limiting course. The unique clinical picture and lack of respinse to empirical antibiotic treatments should alert clinicans to pursue infectious causes other than pyogenic cellulitis.

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