A Case Report of Nocardiosis Occurring in the Quadratus Femoris Muscle.

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We will now report an extremely rare case of Nocardiosis which initially occurred in the quadratus femoris muscle. A 60-year-old man was admitted to our hospital with complaints of swelling and pain in his right thigh and general high fever. Based on clinical symptoms, a blood examination and a MRI, the patient seemed to be suffering from an inflammatory suppurative disease, such as myositis purulenta acuta. As an ultrasonic examination demonstrated evidence of an abscess-like cyst formation within the vastus intermedius muscle, we performed needle aspiration under echo and collected a milky white pus-like secretion. A picture of a direct smear of it showed a lot of gram-positive branched bacteria, which was characteristic of a nocardial infection. Both a giant yellow growth with Sabrouad's agar medium after a one month culture and a transparent zone with Casein medium led us to conclude that the lesion was of Nocardia brasiliensis. As the patient's condition was uneventful after the administration of sulfa drugs, it was followed by an open drainage.To the best of our knowledge, the case presented here is one of a few cases of Nocardiosis which primarily occur in muscles of patients having neither an underlying general disease nor trauma. As about three quarters of the patients used to die within about 6 months before the discovery of sulfa drugs, an exact and prompt diagnosis and treatment seem to be necessary for this disease.