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Actinomycetoma: a therapeutic challenge
  1. Sylvia Aide Martínez-Cabriales,
  2. Jorge Ocampo-Candiani,
  3. Esperanza Welsh,
  4. Ana Sofía Ayala-Cortés,
  5. Minerva Gómez-Flores,
  6. Oliverio Welsh
  1. Department of Dermatology, Universidad Autónoma de Nuevo León, Hospital Universitario ’Dr. José Eleuterio González', Monterrey, Nuevo Leon, Mexico
  1. Correspondence to Dr Oliverio Welsh, Universidad Autonoma de Nuevo Leon Facultad de Medicina, Dermatology University Hospital, Monterrey 64460, Nuevo Leon, Mexico, USA; owelsh{at}

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A 34-year-old otherwise healthy male patient developed multiple nodules with a purulent exudate involving 80% of his left thigh and knee after a cactus-thorn injury 13 years' earlier. He received several unspecified treatments with antibiotics without improvement. The patient presented with swelling of the thigh, multiple abscesses and fistulae draining pus (figure 1). Direct examination of the exudate with 20% KOH as well as histopathology revealed a Nocardia sp. grain. Additionally, Nocardia brasiliensis (Nbr) was isolated in culture, and antibodies against Nbr were positive (1.3917 O.D.).1 Unfortunately, antibiotic susceptibility tests …

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  • Contributors SAM-C wrote the first draft of the manuscript and submitted the manuscript. JO-C was in charge of the patient and collected the data, ASA-C and MG-F did the follow-up of the patient, and EW and OW critically revised the manuscript. All authors approved the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.