Lenskaya Volha, DeChavez Vincent, Kaufman Bridget, Caplivski Daniel
Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States.
Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States.
IDCases. 2021 Mar 18;24:e01078. doi: 10.1016/j.idcr.2021.e01078. eCollection 2021.
Primary cutaneous nocardiosis accounts for 5-8 % of all nocardiosis cases and represents a diagnostic dilemma among immunocompetent and immunocompromised hosts. Herein, we present a case of a 30-year-old male with history of psoriasis with recent addition of Apremilast. Patient received intralesional triamcinolone injections for psoriatic plaques on the hands and abdomen prior to traveling to warm climate vacation. While on vacation, patient developed hand swelling and painful, red nodules on the dorsal hands and abdomen, sites where he received intralesional injections. Patient was empirically given doxycycline, but continued to develop new nodules. An abdominal lesion was biopsied for H&E and tissue culture. Tissue culture revealed beaded gram-positive rods identified as by MALDI-TOF. Patient was switched to trimethoprim-sulfamethoxazole with significant improvement. This case represents an atypical primary cutaneous nocardiosis with most likely in the setting of intralesional steroid injections and possible contribution of Apremilast.
原发性皮肤诺卡菌病占所有诺卡菌病病例的5%-8%，在免疫功能正常和免疫功能低下的宿主中均构成诊断难题。在此，我们报告一例30岁男性病例，该患者有银屑病病史，近期加用了阿普米司特。患者在前往温暖气候地区度假前，因手部和腹部的银屑病斑块接受了曲安奈德皮损内注射。度假期间，患者手部出现肿胀，手背和腹部（即接受皮损内注射的部位）出现疼痛性红色结节。患者经验性使用多西环素治疗，但仍不断出现新的结节。对一个腹部病变进行了组织活检，做苏木精-伊红染色（H&E）和组织培养。组织培养显示有念珠状革兰氏阳性杆菌，通过基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）鉴定为[此处原文缺失具体菌种信息]。患者改用复方磺胺甲恶唑治疗后病情显著改善。该病例代表了一种非典型的原发性皮肤诺卡菌病，极有可能是在皮损内注射类固醇以及阿普米司特可能起作用的情况下发生的。
