[Pulmonary nocardiosis with skin and subcutaneous dissemination. An imitator mimicking tuberculosis].

Nocardiosis is a localized or disseminated infection caused by an aerobic bacteria, usually introduced through the respiratory tract. The pulmonary event may provoke an acute or chronic process mimicking tuberculosis. We herein report a case of pulmonary nocardiosis with skin and subcutaneous dissemination, presenting with the clinical manifestations similar to pulmonary tuberculosis. A 60-year-old male was admitted to the hospital because of a left upper cavitary lung lesion in combination with old treated pulmonary tuberculosis, chronic obstructive pulmonary disease, diabetes mellitus, and drug-induced adrenal insufficiency. Clinical presentations manifested as pulmonary tuberculosis in the beginning, but the left cavitary lung lesion progressed to both lungs and disseminated to produce skin and subcutaneous abscesses in spite of antituberculous therapy. Eventually, Nocardia spp. was found by the Gram's stain, the modified acid-fast stain, and cultures of sputum and subcutaneous abscesses. Thereafter, he received treatment for nocardiosis with trimethoprim/sulfamethoxazole for 30 weeks. Twenty-six months later after discontinuing trimethoprim/sulfamethoxazole, the recurrence of Nocardia was noted from sputum. Therefore, if there is no improvement after antituberculous therapy for patient with the cavitary lung lesion due to possible pulmonary tuberculosis, then the possibility of nocardiosis should be considered, especially when progressive lung lesion or extrapulmonary dissemination develops.