LAUSR

Dear Editor, Nocardia sp is an agent that causes opportunistic infections in immunosuppressed subjects. Most cases of cutaneous nocardiosis correspond to secondary forms, as a consequence of the extension of the bacteria to the skin from a pulmonary focus. Primary forms are infrequent and are not generally considered in the differential diagnosis of skin infections in healthy subjects. A 58-year-old male, with a history of hypertension undergoing pharmacological treatment, was assessed for a painful scalp lesion for 5 days. He had received amoxicillin-clavulanic acid 875/125 mg orally for 3 days without response. In the last 48 h he also associated swelling in the preauricular region. He did not present fever or respiratory symptoms although he remembered a small trauma in the scalp in the previous days with a window. Physical examination showed an erythematoedematous plaque, not fluctuating, with several pustules on the surface (Figure 1), as well as a mass with unscathed skin surface in the right preauricular area. An ultrasonography of the facial and cervical region showed an intraparotid collection associated with enlarged regional nodes (Figure 2). An exudate of the contents of the pustules was taken and Nocardia sp was identified by MALDI-TOF mass spectrometry. Blood tests showed an increased leukocyte count (13 200 cells/ml, 74% neutrophils) without other relevant analytical findings. Given these findings and the excellent