DOI: 10.36347/sjmcr.2017.v05i11.029

Pages: 786-788

A 67-year-old man who had had difficulty moving due to a fever and right leg pain was admitted to our hospital, where his circulation became unstable. He had a history of pemphigoid, diabetes mellitus and renal failure treated by steroid and trimethoprim/sulfamethoxazile (TMP/SMX). Whole-body computed tomography revealed multiple small nodular lesions in the bilateral lung fields, which suggested abscess formation in the right leg. The patient was administered steroids, meropenem and TMP/SMX after drainage of the leg abscesses, as Gram stain revealed the presence of Gram-positive rod-shaped bacteria, suggesting Nocardia or Actinomyces species infection. After confirming that the infection had subsided with no recurrence, he was transferred to a rehabilitation facility on the 76th hospital day. Early decision-making regarding treatment based on the findings of Gram staining and broad-spectrum antibiotics were required to obtain a favorable outcome in this case of invasive nocardiosis.