Primary cutaneous nocardiosis due to Nocardia farcinica in an immunocompetent patient: A case report

Nocardia is an opportunistic pathogen that can present as pulmonary, central nervous system, or disseminated infection in immunocompromised host. However, primary cutaneous Nocardia infections have distinctive presentations in immunocompetent hosts. When infecting a host with an intact immune system, the infection tends to be more insidious, delaying accurate diagnosis and leading to inadequate treatment and persistent infection. Herein, we present a rare case of post-operative cutaneous nocardiosis in a 57-year-old immunocompetent patient with a delay in therapy resulting in a prolonged non-healing wound. Nineteen case reports were reviewed to identify trends in immune status, exposure, treatment regimens, and responses to therapy in both immunocompromised and immunocompetent patients with Nocardia farcinica cutaneous infection. This case report summarizes characteristics of patient populations where N. farcinica might be suspected and emphasizes the importance of a thorough environmental and occupational history in the case of immunocompetent patients. It also addresses challenges in the treatment of cutaneous N. farcinica as related to empiric therapy, antibiotic resistance, and duration of treatment, ultimately providing an algorithm to approach the management of primary cutaneous nocardiosis.