Mycetoma of the chest wall due to Nocardia brasiliensis.

Sir, Nocardiosis is an uncommon but world-wide infection caused by several species of soil-borne aerobic bacteria belonging to the genus Nocardia (1). Nocardiosis can be divided into two broad categories: disseminated and cutaneous. Disseminated nocardiosis, which accounts for most occurrences of nocardiosis, is most commonly caused by N. asteroides, and typically affects immunocompromised hosts, although individuals with presumed immunocompetency also can develop the disease (1, 2). Among the several species of Nocardia causing cutaneous infections, N. brasiliensis is the commonest species isolated (3, 4). Recently, new species including N. mexicana and N. veterana were reported as causative agents of human mycetoma (5, 6). Cutaneous involvement with N. asteroides is usually secondary to haematogenous dissemination from a pulmonary focus. The commonest predisposing event in all the reported cases of primary cutaneous nocardiosis is a local trauma caused by thorns or splinters or, less commonly, insect bites and cat scratches (7, 8). It is most commonly caused by N. brasiliensis, typically affects immunocompetent individuals, and can be subdivided into 3 clinical entities, including: lymphocutaneous infection, mycetoma, and superficial skin infection, including ulceration, abscess, and cellulites (8–10). An intermediate form of the disease between mycetoma and superficial skin infection has been reported recently (4). We report here a case of an immunocompetent female adolescent patient with extensive and destructive primary cutaneous nocardiosis over the thoracic wall and neck.