Nocardia abscessus Cutaneous Abscess: A Case Report and Review of the Literature

We describe a cutaneous abscess caused by Nocardia abscessus in a previously healthy woman. A 74year-old woman presented with recurrent bullae on her left forearm that developed 1 week prior and was initially suspected to be a cutaneous infection with Mycobacteria or Tinea corporis. Histopathologically, the skin lesion formed an abscess. A smear revealed a few branched Gram-positive filamentous microorganisms that formed a creamy white colony on a blood agar plate after incubation for 3 days. The colony tested negative on acid-fast bacilli (AFB) staining, but was positive on modified AFB staining. The isolate was confirmed to be N. abscessus by 16S rRNA sequencing analysis. The isolate was susceptible to trimethoprim-sulfamethoxazole, amikacin, cefotaxime and erythromycin but resistant to penicillin. The patient was treated with clarithromycin but subsequently lost to follow-up. To the best of our knowledge, this is the first report of a human cutaneous infection with N. abscessus in Korea. (Ann Clin Microbiol 2018;21:64-67)