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August 2007

Nocardia otitidiscaviarum: Cause of Long-term Cutaneous Abscesses on the Leg of an Immunocompetent Man

Arch Dermatol. 2007;143(8):1073-1087. doi:10.1001/archderm.143.8.1086

A 55-year-old Turkish man living in northern Germany for 3 decades showed multiple, inflammatory, indurated cutaneous nodules and abscesses that were restricted to his left leg (Figure 1A and B). The lesions had slowly progressed in size and number over 20 years. The patient did not show any inguinal lymphadenopathy or systemic signs of infection and was otherwise healthy.

The results of laboratory tests, including differential blood cell count, routine biochemical analysis, C-reactive protein assay, serum protein electrophoresis, evaluation of paraproteins, autoantibody diagnostics (antinuclear antibody, extractable nuclear antigen, and antineutrophil cytoplasmic antibody), hepatitis serologic analysis, human immunodeficiency virus testing, tuberculosis diagnostics, and superficial smear tests from secreted pus, were all normal. The erythrocyte sedimentation rate was slightly elevated at 33 mm/h, indicating a mild inflammatory process. A computed tomographic (CT) scan of the left leg excluded any muscle or bone involvement. A CT scan of the chest, abdominal and nodal ultrasonography, and magnetic resonance imaging of the brain revealed no abnormalities, excluding any other disease or neoplasm.

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