PMC7328479_01
Right middle finger papule, with lymphangitis tracking up patient's forearm.
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Patient reported a papular lesion on her right middle finger (Figure 1), which was progressively enlarging with swelling, and pain, ultimately ulcerating within a week of onset. During the second visit to the emergency department, 2 tender ulcers on the middle phalanx of right middle finger with tender nodular lymphangitis tract leading up her forearm were found on the patient (Figure 1) with right axillary lymphadenopathy.
Positive acid fast filaments of Nocardia pseudobrasiliensis.
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However, wound culture revealed growth of filamentous acid fast organisms (Figure 2), and medications were changed to intravenous trimethoprim-sulfamethoxazole followed by oral formulation.