Granier F, Kahla-Clémenceau N, Richardin F, Leclerc V, Bourgeois-Droin C, Bérardi-Grassias L, Trémolières F
Service de Dermatologie, Hôpital François-Quesnay, Mantes-la-Jolie.
Presse Med. 1994 Feb 19;23(7):329-31.
Nocardiosis is a rare localized or systemic infection caused by bacteria of the Actinomycetaceae family. Nocardia farcinica, recently identified as a distinct species from Nocardia asteroides, characteristically causes severe systemic infections and is particularly resistant to antibiotics. We report a case of nocardiosis observed in a patient receiving general corticosteroid therapy for bullous pemphigoid and who developed a sub-cutaneous abscess of the breast. N. farcinica was identified on puncture specimens and found to be resistant to beta-lactams, aminosides, cyclines, chloramphenicol, fosfomycin and pefloxacin. No dissemination beyond the skin was observed. The abscess was drained and cleaned surgically and cicatrization was uneventful. Six weeks later the patient was again hospitalized for an inflammatory abscess of the left buttocks which was drained surgically. N. farcinica was again identified and a complete work-up eliminated dissemination. Cotrimoxazole was given as a long-term therapy (480 mg trimethoprim, 2.4g sulfamethoxazole) for 6 months and was well tolerated. No recurrence was observed.
诺卡菌病是一种由放线菌科细菌引起的罕见的局部或全身感染。豚鼠诺卡菌，最近被鉴定为与星形诺卡菌不同的一个菌种，其特征是引起严重的全身感染，并且对抗生素具有特别的耐药性。我们报告了一例在接受大疱性类天疱疮全身皮质类固醇治疗的患者中观察到的诺卡菌病病例，该患者出现了乳房皮下脓肿。在穿刺标本中鉴定出豚鼠诺卡菌，发现其对β-内酰胺类、氨基糖苷类、四环素类、氯霉素、磷霉素和培氟沙星耐药。未观察到皮肤以外的播散。脓肿通过手术引流和清理，愈合过程顺利。六周后，患者因左臀部炎性脓肿再次住院，该脓肿通过手术引流。再次鉴定出豚鼠诺卡菌，全面检查排除了播散。给予复方新诺明进行长期治疗（甲氧苄啶480毫克，磺胺甲恶唑2.4克），持续6个月，耐受性良好。未观察到复发。
