Cutaneous nocardiosis associated with hemolytic anemia and generalized ringworm. A case report and taxonomic comments on the isolated Nocardia asteroides.:A Case Report and Taxonomic Comments on the Isolated Nocardia asteroides
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A case of cutaneous nocardiosis associated with hemolytic anemia and generalized ringworm is presented. A 54-year-old man noticed a subcutaneous nodule on the right thigh without any history of trauma in January 1988. Since that time he had been treated with oral administration of corticosteroid for hemolytic anemia and topical antifungal ointment for generalized ringworm. Physical examination revealed a 67×54mm, firm, subcutaneous nodule on the inner part of the right thigh, and many scaled erythemas with or without infiltration on the trunk and extremities. His fingernails and toenails were thickened and discolored. Trichophyton rubrum was isolated from the erythematous lesions. Biopsy of the subcutaneous nodule revealed extensive abscesses with numerous Gram-positive filaments in the subcutaneous fat tissue. The organism isolated from the biopsy specimen yielded folded, orange-colored colonies on Sabouraud's dextrose agar, later identified as Nocardia asteroides by cell wall composition and physiological characteristics. He was successfully treated with griseofulvin for generalized ringworm, surgical drainage and administration of antibiotics for the nocardial subcutaneous abscess. However, a nocardial metastatic abscess was noted in the abdominal wall 2.5 months after therapy was discontinued.A review of 11 reported cases of secondary cutaneous nocardiosis in Japan and taxonomic comments on the isolated Nocardia asteroides are presented.
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