PMC6167885_01
a Red erythematous papules (4*3 cm) of cutaneous nocardiosis. b Erythematous papules forming the plaque with erosions, pus discharge, and crusting. c The erythematous plaque reduced and resolve after successful treatment with TMP-SMX
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Fig1
Hospital with red erythematous papules near around the previous site of renal transplantation(Fig. 1a). He had lived with diabetes and hypertension for 27 years and had a history of visiting the south-western and south-eastern region of the USA. On clinical examinations, few red erythematous papules with erosions and crusting seen over the site of prior the scar (Fig. 1b); no other systemic abnormality were found to be associated. He has now completed 2 months of treatment; has undergone progressive changes no relapse noted (Fig. 1c); transplant function observed in a good state.
AFB staining: partially acid-fast branching rod suggestive Nocardia species on modified. Kinyounstain (1000x original magnification)
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Fig2
Fast Bacilli (AFB) was observed on Ziehl-neelson staining (Fig. 2); chalky white adherent colonies were seen on aerobic culture after 72 h of incubation, which turns molar tooth appearance on further incubation (Figs. 3 and 4). Further, identification of the isolate, Nocardia asteroids, was done with standard microbiological culture methods as recommended by American Society for Microbiology, based on phenotypic characteristics, biochemical interpretations, and varied incubation temperature to grow the pathogen; since molecular analysis and sequencing was not accessible in our laboratory setting.