Recurrent Subcutaneous Abscess Due to Nocardia farcinica in an Immunocompetent Patient: A Case Report.

Background: Nocardia farcinica differs from other species of Nocardia due to its multi-drug resistance and propensity to disseminate hematogenously. Cutaneous nocardiosis in immunocompetent patients is rare.
Purpose: To describe the treatment and clinical trajectory of a 37-year-old male patient who was not immunocompromised and presented with a history of minor trauma from a canister and palpable subcutaneous draining nodules in the forearm. Purulent drainage was present. The injury had occurred 3 months before presentation.
Results: Magnetic resonance imaging revealed multiple abscess foci up to 3 cm in diameter in the forearm muscles. The wound culture obtained after debridment indicated Nocardia farcinica as the cause. The case was difficult to manage despite serial debridements, negative pressure wound dressings, and culture-specific antibiotic treatments. The entire treatment process took approximately 7 months. The patient had 5 surgical interventions and more than 6 months of antibiotic treatment. Healing was eventually achieved but with a painful scar.
Conclusion: Although nocardiosis has been documented to occur primarily in immunocompromised patients, it should be considered in the differential diagnosis of immunocompetent patients if there is a history of skin injury and a late-onset subcutaneous draining abscess resistant to common treatment regimens.