PRIMARY CUTANEOUS NOCARDIOSIS SECONDARY TO NOCARDIA ASTEROIDES: AN UNUSUAL PRESENTATION AT A RARE SITE

Primary cutaneous nocardiosis can present as an abscess or cellulitis with sporotrichoid morphology. Deep inoculation in the subcutaneous tissue can present as a mycetoma. Mycetoma over the elbow region is rare. We herein describe a case of primary cutaneous nocardiosis presenting as a mycetoma, caused by Nocardia asteroides. The patient had extensive keloidal lesions with few sinuses extruding serous discharge over the right forearm around elbow joint. Initially pus and later, the deep tissue biopsy samples were sent for culture and sensitivity, without suspecting nocardial infection. Gram stain of the pus showed few WBCs and occasional Gram positive branching filaments. Modified Kinyoun stain of the same revealed acid-fast filamentous structures. Culture of the tissue specimen yielded Nocardia asteroides. The patient responded well to a modified Ramam's regime. On follow-up, the patient showed no recurrence at 1 year. Our case demonstrates the need for focused clinical search with a high degree of suspicion, and appropriate laboratory procedures in the diagnosis and management of cutaneous nocardiosis.