Multiple cutaneous abscesses revealing disseminated nocardiosis in a patient with chronic rheumatoid arthritis

Nocardiosis is a challenging infection that is difficult to diagnose and treat. Delayed recognition and prolonged illness are major concerns. We report the case of a 65-year-old man who underwent treatment with corticosteroids for rheumatoid arthritis and then presented with multiple abscesses on the right leg. A complete assessment performed by the dermatologist led to the diagnosis of disseminated nocardiosis with involvement of the lungs and central nervous system. The patient's history revealed development of pulmonary disease approximately 1 year prior to the appearance of the skin lesions, which was not recognized by several specialists. Long-term antibiotic therapy was effective in treating the skin and central nervous system lesions, while the chest radiologic profile improved more slowly.