Necrotizing soft tissue infection due to Nocardia brasiliensis in an immunocompetent host

A male in early 70’s with no known immunocompromising conditions developed progressive swelling, pain, and erythema of his left lower extremity (LLE) over 2 weeks following multiple abrasions to his LLE by a thorny bush while working in a brush field. He was found to have multiple purple bullae on the anterior surface of the distal half of the LLE, swelling, induration, and exquisite tenderness along with leukocytosis of 17,000 cells per milliliter, and elevated creatinine 1.75 mg/dl. and non loculated fluid collections under the cutaneous lesions on ultrasound. During excisional debridement, liquefied skin and subcutaneous tissue and necrotic subcutaneous fat were seen. Tissue cultures grew Nocardia brasiliensis (N.brasiliensis). Minocycline was given for 3 months due to renal dysfunction with Trimethoprim-sulfamethoxazole (TMP-SMX). He had skin grafting of the leg wound and had complete healing of his wound. N. brasiliensis is an infrequent cause of primary necrotizing skin infections in immunocompetent people.