Ann Lab Med.  2013 May;33(3):203-207. 10.3343/alm.2013.33.3.203.

The First Korean Case of Disseminated Mycetoma Caused by Nocardia pseudobrasiliensis in a Patient on Long-Term Corticosteroid Therapy for the Treatment of Microscopic Polyangiitis

• Seol CA
• Sung H
• Kim DH
• Ji M
• Chong YP
• Kim MN

• KMID: 1781328
• DOI: http://doi.org/10.3343/alm.2013.33.3.203

Abstract

Nocardia pseudobrasiliensis is predominantly associated with invasive infections in immunocompromised patients. We report a case of disseminated mycetoma caused by N. pseudobrasiliensis in a 57-yr-old woman with microscopic polyangiitis, who was treated for 3 months with corticosteroids. The same organism was isolated from mycetoma cultures on the patient's scalp, right arm, and right leg. The phenotypic characteristics of the isolate were consistent with both Nocardia brasiliensis and N. pseudobrasiliensis, i.e., catalase and urease positivity, hydrolysis of esculin, gelatin, casein, hypoxanthine, and tyrosine, but no hydrolysis of xanthine. The isolate was identified as N. pseudobrasiliensis based on 16S rRNA and hsp65 gene sequencing. The patient was treated for 5 days with intravenous ampicillin/sulbactam, at which time both the mycetomas and fever had subsided and discharged on amoxicillin/clavulanate. This case highlights a very rare presentation of mainly cutaneous mycetoma caused by N. pseudobrasiliensis. This is the first reported case of N. pseudobrasiliensis infection in Korea.

Keyword

Nocardia pseudobrasiliensis; Mycetoma; Corticosteroids; 16S ribosomal RNA; hsp65

MeSH Terms

Adrenal Cortex Hormones/*therapeutic use
Asian Continental Ancestry Group
Bacterial Proteins/chemistry/genetics
Female
Humans
Microscopic Polyangiitis/complications/*drug therapy
Middle Aged
Mycetoma/complications/*diagnosis/microbiology
Nocardia/genetics/*isolation & purification
RNA, Ribosomal, 16S/chemistry/genetics
Republic of Korea
Scalp/microbiology/pathology
Sequence Analysis, DNA
Skin/microbiology
Adrenal Cortex Hormones
Bacterial Proteins
RNA, Ribosomal, 16S

Figure

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  Fig. 1 Solitary erythematous nodules on the patient's scalp (A) and right arm (B). Histopathological findings of tissue biopsied from the scalp (C) included inflammation and abscess formation (H&E stain, ×100).

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  Fig. 2 (A) The Gram-stained smear of a cultured colony reveals thin and filamentous branching rods (×1,000). (B) Modified-Kinyoun staining reveals weakly positive dotted rods (×1,000). (C) The morphology of colonies of the isolate on SDA after 3-week incubation. (D) Biochemical tests, including the opacification of Middlebrook 7H10 (a) and the hydrolysis of casein (b), xanthine (c), hypoxanthine (d), and tyrosine (e), were interpreted after a 5-day incubation at 35℃. The organism was negative for Middlebrook 7H10 opacification and xanthine hydrolysis but positive for casein, hypoxanthine, and tyrosine hydrolysis (lower row). The un-inoculated media (upper row) are shown for comparison.Abbreviation: SDA, Sabouraud dextrose agar.

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