Santa Casa de Misericórdia de Belo Horizonte, Minas Gerais, Brazil.
Int J Dermatol. 2010 Jan;49(1):56-8. doi: 10.1111/j.1365-4632.2009.04263.x.
Mycetoma is a chronic subcutaneous mycosis caused by exogenous fungi or actinomycetes. This infection has a progressive course and shows a typical clinical characteristic of tumefaction, draining sinuses, and grains. Infection initiation is related to local trauma and can spread to muscle, underlying bone, and adjacent organs. Nocardia brasiliensis is the most frequent actinomycete isolated, while N. caviae is a rare agent.
We present a case of mycetoma in a 37-year-old African-American man on the right hand. The infection had been apparent for four years prior to the consultation. When the infection did not respond to antibiotic therapy, the patient was referred to the Dermatology department. Routine laboratory studies were normal. X-ray examination of the hand showed an osteolytic lesion on the hand bones. On skin biopsy culture, on Sabouraud Dextrose Agar at 28 degrees C, a colony was isolated which was further identified as N. caviae by biochemical and hydrolysis testing.
The patient was treated with oral trimethoprim/sulfamethoxazole (TMP/SMZ) 160/800 mg twice a day for 10 months. Four months after the beginning of the therapy, the subject exhibited clinical improvement and functional recovery of the hand. Five-year follow-up X-ray examination of the hand showed no osteolytic lesion on the hand bones.
We report the first mycetoma case caused by N. caviae in our country with an unusual location on the hand. The patient showed clinical improvement with oral TMP/SMZ.
足菌肿是一种由外源性真菌或放线菌引起的慢性皮下真菌感染。这种感染具有进行性病程，并表现出典型的临床特征，包括肿胀、窦道引流和颗粒状。感染的起始与局部创伤有关，可扩散至肌肉、深部骨骼和相邻器官。巴西诺卡菌是最常分离到的放线菌，而卡氏诺卡菌则较为罕见。
我们报告了一例发生在右手的 37 岁非裔美国男性的足菌肿病例。该感染在就诊前已经存在四年。当感染对抗生素治疗没有反应时，患者被转至皮肤科。常规实验室研究正常。手部 X 光检查显示手部骨骼有溶骨性病变。皮肤活检培养在 28°C 的沙氏葡萄糖琼脂上，分离出的菌落经生化和水解试验进一步鉴定为卡氏诺卡菌。
患者接受口服复方磺胺甲噁唑（TMP/SMZ）治疗，剂量为 160/800mg，每日两次，共治疗 10 个月。治疗开始后 4 个月，患者表现出临床改善和手部功能恢复。手部 X 光检查随访 5 年，手部骨骼未见溶骨性病变。
我们报告了我国首例手部卡氏诺卡菌引起的足菌肿病例，其位置不常见。患者口服 TMP/SMZ 后临床症状改善。
