Bogaard H J, Erkelens G W, Faber W R, de Vries P J
Afd. Longziekten, Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, 1100 DD Amsterdam.
Ned Tijdschr Geneeskd. 2004 Mar 13;148(11):533-6.
A 46-year-old man who had been treated with azathioprine and budesonide for Crohn's disease for the past eight years developed a purulent skin condition on the right ring finger. Despite surgical drainage and treatment with amoxicillin and flucloxacillin, the condition spread itself over the hand and lower arm, partly per continuum and partly in jumps. The patient did not feel ill and there were no systemic symptoms. Ultimately, Nocardia asteroides was cultured from the wound and complete cure was achieved after 8 months' treatment with co-trimoxazole. Infections with Nocardia spp. are rare but may occur more often and run a more fulminant course in patients under treatment with immunosuppressants. Cutaneous nocardiosis generally has a characteristic lymphogenous spreading pattern, but an atypical picture with pustules, pyoderma, cellulitis or abscess formation is also possible. In non-cutaneous nocardiosis there is usually pneumonia or lung abscess, possibly with secondary haematogenous spread to the central nervous system or skin. Culturing Nocardia requires more time than usual but can be promoted by special culture media. Treatment of the infection with co-trimoxazole is the method of choice and is almost always successful in cases of cutaneous nocardiosis.
一名46岁男性，在过去八年中一直使用硫唑嘌呤和布地奈德治疗克罗恩病，右手环指出现化脓性皮肤病症。尽管进行了手术引流，并使用阿莫西林和氟氯西林治疗，但病情仍蔓延至手部和下臂，部分呈连续性蔓延，部分呈跳跃式蔓延。患者无不适感觉，也无全身症状。最终，从伤口培养出星形诺卡菌，使用复方新诺明治疗8个月后实现完全治愈。诺卡菌属感染较为罕见，但在接受免疫抑制剂治疗的患者中可能更常发生且病情更为迅猛。皮肤诺卡菌病通常具有典型的淋巴源性传播模式，但也可能出现伴有脓疱、脓皮病、蜂窝织炎或脓肿形成的非典型表现。在非皮肤诺卡菌病中，通常会出现肺炎或肺脓肿，可能继发血行播散至中枢神经系统或皮肤。培养诺卡菌所需时间比平常更长，但特殊培养基可促进其生长。使用复方新诺明治疗该感染是首选方法，在皮肤诺卡菌病病例中几乎总能取得成功。
