A case of disseminated nocardiosis secondary to the skin nodules in an old woman

초록

Nocardiosis refers to locally invasive or disseminated infection associated with Nocardia species. Most infections enter through respiratory tract and then disseminate systemically. Occasionally primary nocardial infection of the skin may spread to contiguous structures or disseminate other internal organs in immunocompromised hosts. We describe a 70 year-old woman who suffered from recurrent painful nodules on her right hand, forearm and elbow following a trauma. She was thin and did not have any underlying diseases. Laboratory and radiological examinations were not characteristic except mild anemia. During the treatment with various broad-spectrum antibiotics combined with antifungal agents, a chest x-ray showed newly developed multiple nodules in both lungs. After confirmation of the pathologic organisms obtained from the skin nodules as Nocardia spp., we diagnosed her as disseminated nocardiosis secondary to the skin lesions. Her skin lesions were cleared after 2-month treatment with trimethoprim-sulfamethoxazole, and at present, after 5 months, she is treated continuously for her lung lesions.