PMC5433578_01
Left temporal artery enlargement with local tenderness.
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One week before, physical examination had shown an enlarged painful left temporal artery and a previously absent right frontal scar, most probably a cutaneous superficial atrophy due to vasculitis (Figure 1a, b).
Right frontal scar, occurred spontaneous, likely due to vasculitis-related skin atrophy. There are also small areas of cutaneous necrosis.
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Ultrasonography, performed with an Esaote MyLab  Five machine with a 10-13 MHz multifrequence linear transducer, showed an aspect compatible with an abscess (Figure 2).
Hypoechogenyc heterogeneous lesion located in soft parts of the frontal region, extending dermo-epidermal and possible tendency to fistulization.
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The microscopic examination revealed Gram-positive long thin branching roads and culture on Colombia blood agar was indicative of Nocardia spp. with white chalky colonies after 3 days of incubation (Figure 3).