Primary Cutaneous Nocardiosis- A Diagnostic Dilemma

Abstract

A 38-year-old male, working as a supermarket manager, developed multiple painful nodules on the face and arms associated with generalised weakness of 2 months duration. His medical history was otherwise uneventful. There was no previous history of any trauma or medication. He was investigated in a nearby hospital and was treated as cutaneous vasculitis with systemic corticosteroids. But there was no improvement in the symptoms. Few weeks later, he developed similar new lesions on the chest and abdomen. Few lesions evolved to form an abscess, along with which he developed regional lymphadenopathy and fever. He consulted a different doctor and there he was diagnosed to have Cutaneous Tuberculosis and was started with Anti-Tuberculosis Therapy (ATT). Since there was no much improvement after 3 months of starting ATT, he was referred to our medical college. On presentation, general examination revealed multiple tender, discrete lymph nodes of about 2 x 1 cm size in the axilla, neck and groin.