Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology

Translate this page into:

Case Report

Sporotrichoid pattern of cutaneous nocardiosis

AC Inamadar, A Palit
 Department of Dermatology, Venereology & Leprology, BLDEAS SBMP Medical College, Hospital & Research Centre, Bijapur, Karnataka, India

Correspondence Address:
A C Inamadar
Department of Dermatology, Venereology & Leprology, BLDEAS SBMP Medical College, Hospital & Research Centre, Bijapur, Karnataka
How to cite this article:
Inamadar A C, Palit A. Sporotrichoid pattern of cutaneous nocardiosis. Indian J Dermatol Venereol Leprol 2003;69:33-34
Copyright: (C)2003 Indian Journal of Dermatology, Venereology, and Leprology


A young male patient, having linearly arranged nodular lesions on lower extremity was diagnosed to have lymphocutaneous variety of cutaneous nocardiosis. This is a rare entity and has to be differentiated form other causes of nodular lymphangitis. The patient responded dramatically to Cotrimoxazole therapy.
Keywords: Cutaneous nocardiosis, Sporotrichoid pattern, Nodular lymphangitis


Nocardia species is known to infect different organ systems of human body including skin.[1] Since there is no distinctive clinical feature for this infection, it is easily misdiagnosed unless high level of clinical suspicion is employed. Cutaneous nocardiosis occuring in sporotrichoid pattern is relatively rare,[2] and countable cases are reported worldwide till date.[2] Here we describe a young male patient with nodular lymphangitis of lower extremity caused by nocardia species.

Case Report

A 16 years old male patient presented with multiple linearly arranged nodular lesions over right lower extremity. It started over the dorsum of foot as a small solitary painful nodule following a botanical injury 3 months back. On clinical examination, firm, tender, nodular lesions of 1.5-2.5 cm were seen arranged in a line, extending from dorsum of right foot to the front of the leg. The intervening skin between the nodules was erythematous with palpable cordlike structures. Some of the nodules were suppurative and one had a verrucous surface. There was no sinus or discharge of granules from the lesions. Inguinal lymph nodes on right side were palpable and tender.

Routine haematological, biochemical and radiological examinations were within normal limits. Gram stain and modified AFB stain of the aspirated material from a suppurative lesion showed thin branching filaments KOH preparation was negative for any fungal elements. Culture on Sabourad′s agar media did not grow specific organism. Skin biopsy was taken from a nodule and on histopathological examination by H&E stain, it showed granulomatous changes with inflammatory infiltrate in the dermis. Organisms were not demonstrable in the tissue section.

We made a diagnosis of lymphocutaneous nocardiosis and started treatment with Cotrimoxazole DS tablets, twice daily. Clinical improvement was observed within 15 days and there was complete resolution of the lesions after 3 months of therapy. Treatment was continued for further 3 months after clinical resolution.


Primary cutaneous nocardiosis can occur in acute or chronic forms.[3] The chronic form, mycetoma is much commoner than the acute form. Acute cutaneous nocardial infections, also known as superficial nocardial skin infections, present as pustules, abscess or features of cellulitis.[1],[2] In only one third[4] of these cases there is a spread through the lymphatics to the regional lymph nodes, giving rise to lymphocutaneous type.

Soil being the inhabitance of these organisms, primary inoculation by minor injuries like thorn prick, is the usual source of infection.[1] Insect bite and cat scratch are also reported as initiating factors.[5] Extremities are the common site of initial infection and it usually starts as a chancre at the site of inoculation, followed by development of chains of nodules extending proximally.[1],[2]

Nocardia brasiliensis is the most frequently isolated organism form lymphocutaneous variety.[1],[5] It is a highly virulent organism in laboratory animals because of the production of extracellular proteases.[2] Such pattern of infection can also be caused by Nocardia asteroides[5] and Nocardia caviae.[2] Isolation of the species was not possible in our patient. From animal experiments, it is evident that cell mediated immunity plays the pivotal role in host response to nocardia infection.[2] There is macrophage activation and induction of a T cell population capable of direct lymphocyte mediated toxicity to nocardia.[2]

Linear nodular lymphangitic lesion[6] is classically seen in sporotrichosis, caused by a dimorphic fungi, Sporothrix schenckil. Hence it has acquired a special name, the sporotrichoid pattern. However, sporotrichoid lesions can also be caused by Nocardia species,[1],[2],[3],[4],[5] Leishmania brasiliensis,[7],[8] and atypical mycobacteria (M.marinum & M.chelonae).[7] Uncommonly it can be caused by pyogenic bacteria,[9] like Streptococcus pyogenes and Staphylococcus aureus, and deep fungal infections,[7] like primary inoculation forms of blastomycosis, cocoidomycosis, cryptococcosis and histoplasmosis. Rarely, a malignant disease, epithelioid sarcoma,[10] may assume sporotrichoid pattern. Lymphocutaneous nocardiosis is more acute in onset and clinical course of the disease is more inflammatory than sporotrichosis.[2] In contrast to mycetoma, sulphur granules are absent in this variety of disease.[2] Other condition have to be differentiated by careful history, areas of endemicity, laboratory tests, histopathological examination and therapeutic trial.

Nocardia is a slow growing organism and may be difficult to grow from clinical specimens, because other rapidly growing bacteria easily obscure small nocardial colonies.11 Unfortunately, we could not isolate the species of nocardia causing infection in our patient. However, microscopical demonstration of typical morphology of the organism, histopathological evidence of granuloma, and dramatic therapeutic response to cotrimoxazole helped to confirm our clinical impression.

Odom RB, James WD, Berger TG.Diseases resulting form fungi and yeasts. In: Andrews' Diseases of the skin, clinical dermatology,9th edn, Philadelphia: W.B Saunders company, 2000:p 411-412.
[Google Scholar]
Yang, LJ, Chan HL, Chen WJ, Kuo TT. Lymphocutaneous nocardiosis caused by Nocardia caviae: The first case reported from Asia. J Am Acad Dermatol 1993; 29:639-641.
[Google Scholar]
Angelika J. Primary cutaneous nocardiosis in a husband and wife J Am Acad Dermatol 1999; 41:338
[Google Scholar]
Mc Neil MM, Brown JM. The medically important actinomycetes: epidemiology and microbiology. Clin Microbiol Rev 1994; 7:357-417.
[Google Scholar]
Kannon GA, Kuechle MK, Garrett AB. Superficial cutaneous Nocardia asteroides infection in an immunocompetent pregnant woman.J Am Acad Dermatol 1996; 35(6):1000-2.
[Google Scholar]
Kostman JR, DiNubile MJ.Nodular lymphangitis:a distinctive but often unrecognised syndrome.Ann Intern Med.1993; 118:883-888.
[Google Scholar]
Johnson MM, Meier MP.A palmar chancre and multiple proximal erythematous nodules.Arch Dermatol 1996; 132:963-968.
[Google Scholar]
Spier S,Medenica M, McMillian S, Virtue C.Sporotrichoid leishmaniasis.Arch Dermatol. 1977; 113:1104-1105.
[Google Scholar]
Tanaka S, Mochizuki T, Watanabe S.Sporotrichoid pyogenic bacterial infection. Dermatologica.1989; 178:228-230.
[Google Scholar]
Santiago H,Feinerman LK, lattes R.Epithelioid sarcoma : a clinical and parthologic study of nine cases. Hum Pathol 1972; 3:133-147.
[Google Scholar]
Lerner PI. Nocardiosis. Clin Infect Dis 1996 ; 22:891-903.
[Google Scholar]
Show Sections