Treatment of Cutaneous Nocardia Infection in an HIV Patient

Abstract

Objective:

To describe an alternative treatment option in cutaneous nocardiosis.

Case Summary:

A 45-year-old African-American man with HIV infection presented to the hospital for recurrent left-arm cellulitis. The patient had been discharged from the hospital 10 days earlier with the same diagnosis. He had increased pain, tenderness, and swelling of his left arm before admission. The patient was diagnosed with cellulitis and an abscess and admitted to the hospital. The surgical team was consulted and proceeded to drain the abscess. On the third hospital day, the culture grew Nocardia spp.; the microbiology laboratory did not identify the species. The patient was started on oral minocycline 200 mg twice daily. His condition improved, and he was discharged home.

Discussion:

Nocardiosis is a localized or disseminated infection caused by a soil-borne aerobic actinomycete introduced by inhalation, abrasion, or major trauma (cutaneous). Nocardiosis can be difficult to diagnose because of the fastidious nature of the organism. Cutaneous nocardia infections can also be difficult to treat in patients with HIV. The response of nocardia to sulfonamides is excellent, with good clinical improvement within 10 days. However, sulfonamides must be used with caution in patients with HIV because of the large percentage of patients that have a hypersensitivity to sulfonamide compounds. Minocycline is an effective oral alternative for patients unable to tolerate sulfonamide antimicrobials.

Conclusions:

Cutaneous nocardia infections are difficult to diagnose and may require alternative treatment regimens in patients with HIV. Minocycline is an effective alternative to sulfonamide antimicrobials in the treatment of cutaneous nocardia infections.