Palmieri James R, Santo Arben, Johnson Shawn E
Department of Microbiology, Infectious and Emerging Diseases, Blacksburg, VA, USA.
Department of Pathology, Edward Via College of Osteopathic Medicine, Virginia Campus, Blacksburg, VA, USA.
Int Med Case Rep J. 2014 Mar 7;7:41-7. doi: 10.2147/IMCRJ.S59315. eCollection 2014.
A 45-year-old man complained of pain and swelling on his right wrist after receiving a scratch while playing paintball in a swampy area of eastern Virginia. Two weeks later, he noticed a pimple-like lesion developing, which quickly grew in size and then ulcerated. Because of the severity of his condition, the patient was taken to the emergency room where surgical drainage of the abscess was carried out and the pus was sent for culture and sensitivity testing. Enlarged and tender lymph nodes were palpable going up the arm and surrounding the right axillary area. Three days following culture of pus from his lesion, colonies of Nocardia brasiliensis were isolated. He was successfully treated with an extended regimen of trimethoprim-sulfamethoxazole. Because of its low incidence, nocardiosis is usually not considered in the initial diagnosis. The rapidity with which his infection developed from a pimple-like lesion into an extensive ulcerated area, the involvement of his lymphatic system, the extended time needed to successfully treat his infection, and the potential for infection to rapidly disseminate, reinforces the necessity for laboratory identification and immediate treatment of severe pyogenic cutaneous lesions.
一名45岁男性在弗吉尼亚州东部的沼泽地区玩彩弹球时被划伤右手腕后，出现疼痛和肿胀。两周后，他注意到出现了一个丘疹样病变，其大小迅速增大，随后发生溃疡。由于病情严重，患者被送往急诊室，在那里对脓肿进行了手术引流，并将脓液送去进行培养和药敏试验。沿手臂向上及右腋窝周围可触及肿大且有压痛的淋巴结。从其病变处采集脓液培养三天后，分离出巴西诺卡菌菌落。他接受了延长疗程的甲氧苄啶-磺胺甲恶唑治疗并获得成功。由于诺卡菌病发病率较低，初始诊断时通常不会考虑该病。其感染从丘疹样病变迅速发展为广泛的溃疡区域、累及淋巴系统、成功治疗感染所需的延长时间以及感染迅速播散的可能性，都强调了对严重化脓性皮肤病变进行实验室鉴定和立即治疗的必要性。
