A 56 yr old white woman showed an indurated, ulcerated lesion on the dorsal surface of the middle phalanx of the left middle finger and several erythematous nodules on the left forearm. The lesion on the finger appeared several days after working in the garden and the arm nodules developed a few days later. Penicillin and ampicillin were given for 10 days without improvement. At the end of that time, an indurated pustule was present at the site of the primary inoculation with lymphangitis extending up her left forearm. The axillary lymph nodes were enlarged and nontender. Sporotrichosis was suspected on clinical grounds. Microscopic examination of smears revealed the presence of fine gram positive branching organisms. An organism was cultured which was identified as Nocardia brasiliensis, sensitive to erythromycin. Erythromycin, 250 mg t.i.d., was given and potassium iodide, 20 drops t.i.d. The lesions showed slight improvement. The skin biopsy showed epitheliomatous hyperplasia with focal parakeratosis. In both the superficial and deep dermis, noncaseating granulomas were present. This patient with lymphocutaneous infection by Nocardia brasiliensis is the 8th recorded case of this form of the disease and the 1st from Florida.
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