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Primary cutaneous nocardiosis of the head and neck in an immunocompetent patient
  1. Claudio Tirso Acevedo1,
  2. Frank Imkamp2,
  3. Ewerton Marques Maggio3 and
  4. Silvio Daniel Brugger1
  1. 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
  2. 2Department of Medical Microbiology, University of Zurich, Zurich, Switzerland
  3. 3Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Claudio Tirso Acevedo; claudio.acevedo{at}


Nocardiosis is known to be an opportunistic infection most commonly affecting immunocompromised patients that can lead to life-threatening conditions. Primary cutaneous disease remains a rare manifestation and unlike pulmonary or disseminated nocardiosis, it usually affects immunocompetent individuals. We present a case of a primary cutaneous nocardiosis of the head and neck after an insect bite in a healthy 50-year-old woman who had recently travelled from Greece. She presented with a painful right-sided swelling of her face and neck and an ulcerated plaque over the right temple. Biopsy of the plaque revealed inflammation with abscess formation indicating underlying infection. Culture from the biopsy showed growth of Nocardia spp and 16S rRNA gene sequence analysis identified Nocardia brasiliensis. The patient was treated with trimethoprim/sulfamethoxazole and subsequently switched to amoxicillin/clavulanic acid due to a drug eruption. Antibiotic therapy was continued for a total of 3 months with complete resolution of the skin lesions.

  • infectious diseases
  • dermatology

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  • Contributors FI contributed by the acquisition, analysis and interpretation of the microbiological data. EMM contributed by the acquisition, analysis and interpretation of the histopathological data. SDDB contributed to the plan, conception and design. CTA is the corresponding author and contributed to the conduction, plan, conception and design of the work and wrote the first draft of the manuscript. All authors revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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