The First Report of Cutaneous Nocardia Concava Infection in the United States

This is a case report presenting a rare disease, cutaneous Nocardia concava infection. There are currently only five published case studies worldwide describing infections caused by N. concava, and all of them occurred in Far East Asian countries (Japan, China, and Korea). Three of the reported cases were cutaneous infection cases. This is the sixth case to be reported in the world and the first in the United States. A 75-year-old Caucasian female was admitted to a community hospital with recurring cutaneous lesions for four months. Biopsy demonstrated the presence of Nocardia concava, confirmed by DNA sequencing on the hps65 gene. Treatment was achieved with sulfamethoxazole-trimethoprim. This case report creates awareness for family physicians to consider that cutaneous nocardiosis may mimic the cutaneous lesions of sporotrichosis. If a patient fails multiple treatment regimens, advanced microbiological evaluation methods such as DNA sequencing should be considered.