Nocardia vinacea infection with septic articular involvement and tenosynovitis

Nocardiosis, typically affecting immunocompromised patients, can manifest in rare forms like hand tenosynovitis. We report a 91-year-old man with Nocardia vinacea, confirmed by genetic sequencing after negative cultures, likely caused by a gardening injury. The diagnosis was made early, in less than a week, thanks to molecular biology techniques performed directly on the specimen (synovial biopsy), drastically shortening the time needed to introduce antibiotic therapy adapted to Nocardiosis, as the Nocardia culture grew in around a month. This case emphasizes the need for early PCR testing and tailored diagnostic approaches.