# Nocardia vulneris: a rare pathogen in actinomycetoma – a case report and review of the literature

## TL;DR

A rare case of Nocardia vulneris causing actinomycetoma in a man from El Salvador is reported, showing successful treatment with a combination of antibiotics.

## Contribution

This is the first reported case of N. vulneris mycetoma in Central America and confirms the effectiveness of combined antibiotic therapy.

## Key findings

- N. vulneris was identified as the causative agent through molecular sequencing.
- The patient showed significant improvement with trimethoprim–sulfamethoxazole and dapsone treatment.
- This case highlights the rarity of N. vulneris mycetoma at an unusual anatomical site.

## Abstract

Actinomycetoma is a chronic, progressive bacterial infection characterized by granuloma formation, with Nocardia vulneris being a rare causative agent. A 32-year-old healthy man from El Salvador presented with painless nodules, scars and discharging sinus tracts on his back. Examination of the exudate revealed small white grains, and Nocardia species were isolated through culture. Molecular identification of N. vulneris was confirmed via 16S rDNA gene amplification and sequencing. The patient was treated with trimethoprim–sulfamethoxazole and dapsone, resulting in significant clinical improvement after 6 months. He continues on this treatment regimen. This case highlights the rarity of N. vulneris mycetoma at an unusual anatomical site and demonstrates the effectiveness of combined trimethoprim–sulfamethoxazole and dapsone therapy.

Actinomycetoma is a chronic granulomatous bacterial infection, with N. vulneris being a rare associated pathogen. Therapeutic strategies for N. vulneris are primarily based on case reports, with TMP-SMX and dapsone proving effective for localized infections. This case underscores the rarity of N. vulneris mycetoma, which is a first report in Central America and highlights the efficacy of combined TMP-SMX and dapsone therapy.