Abstract: An 84-year-old male with redness, swelling and pain of the right hand for 1 month after being pricked by a cactus, accompanied by fever for 1 week. He had a past medical history of hypertension, coronary heart disease, diabetes mellitus and bladder cancer. Conventional anti-infection was ineffective, and the pus culture was diagnosed as Nocardia brasiliensis infection. Incision and drainage were performed, and trimethoprim sulfamethoxazole and imipenem were given for intensive treatment. At the third week of treatment, liver and kidney function damage and gastrointestinal bleeding occurred, which improved after comprehensive treatment. Then sequential single use of trimethoprim sulfamethoxazole consolidation therapy for 3 months, the skin lesions healed without recurrence. It is suggested that nocardia infection should be vigilant when the purulent skin lesions of skin and soft tissue in patients with underlying diseases of impaired immune function are prolonged, and stepwise long-term monotherapy is safe and effective.

Key words: cutaneous nocardiosis, Nocardia brasiliensis, trimethoprim sulfamethoxazole, adverse drug reactions