Subcutaneous Nocardial Abscesses in a Patient with Bullous Pemphigoid during Immunosuppressive Therapy: Report of a Case and Review of the Japanese Literature

We describe a rare case of multiple, subcutaneous nocardial abscesses. A 67-year-old Japanese male with bullous pemphigoid was admitted to our hospital, and systemic prednisolone and double filtration plasmapheresis were administered. During the combination treatment, he noted a solitary subcutaneous nodule on the right upper arm. The lesions gradually increased in number and disseminated. The microbial diagnosis was thought to be a Nocardia species. Administration of combination chemotherapy with minocycline and diamino-diphenyl sulfone failed to eliminate the nodules completely, so he was treated with daily injection of amikacin sulfate into the nodules. The lesions dramatically responded to this therapy and resolved in four weeks.