Akademik Veri Yönetim Sistemi
Turkish Journal of Dermatology, cilt.18, sa.3, ss.94-98, 2024 (ESCI)
A 77-year-old immunocompetent male agricultural worker presented with a 9-year history of hand stiffness, edema, and draining wounds. Despite two surgeries and antibiotic use many times, his condition persisted. Initially treated for a deep fungal infection with Itraconazole for 9 months without improvement, Nocardia spp. were later identified in deep tissue culture via microbiological examination by Gram-staining and isolation in culture media. He was treated with trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg for six months, leading to regression of the cutaneous lesions. However, magnetic resonance imaging revealed osteomyelitis and tenosynovitis, prompting an extended 12-month treatment with increased doses of TMP-SMX and a month of ceftriaxone. Complete recovery was achieved after 12 months. This case highlights the rarity and diagnostic challenges of nocardiosis, emphasizing the need for thorough microbiological evaluation, extended antibiotic treatment, and imaging follow-up for persistent, deep localized infections. Primary cutaneous nocardiosis should be considered, particularly in patients with non-healing skin lesions and a history of soil exposure.