High fever, new nodules |
ESR 10 mm/h, WBC 7070 mm−3, Hb 13.8 g/L, CRP 9.7 mg/dL |
Ceftizoxime 6 g/d + clindamycin 1800 mg/d |
1st ⇒ 14th days |
Partial resolution, new lesion (chin) |
Ulcerative lesion under chin |
Gram stain: small rods and coccus |
TMP/SXT 10 mg/kg/day + Imipenem 2 g/day |
14th ⇒ 45th days |
New lesions (dorso-thorocal region) bone marrow suppression (WBC 7240 mm−3, Hb 6.7 g/dL, Ht 22.1, PLT 118,000 mm−3) "Breakthrough" |
Disseminated skin lesions + respiratory distress |
Chest radiogram: Pleural empyema Pleural fluid: "Aerobic nocardiform actinomycetes ESR 63 mm/h, CRP 21.6 mg/dL |
Imipenem 2 g/day + amikacin 1 g/day + doxycycline 200 mg/day Surgical: drainage and debridement |
45th ⇒ 90th days |
Resolution of cutaneous lesions and empyema |
Scarred cutaneous lesions |
ESR 38 mm/h, CRP 0.65 mg/dL |
Amikacin 1 g/day + doxycycline 200 mg/day |
3rd ⇒ 4th months |
Relapse |
High fever, new nodules |
ESR 85 mm/h, CRP 5.2 mg/dL |
Imipenem 2 g/day + amikacin 1 g/day+ vancomycine 2 g/day |
4th ⇒ 6th months |
Suppression or cure Discharge from hospital |
None |
ESR 45 mm/h, CRP 0.66 mg/dL |
Doxycycline 200 mg/day |
6th ⇒ 7th months |
Re-activation |
Arthritis (right knee and ankle) |
ESR 95 mm/h, CRP 21 mg/dL |
Ceftriaxone 2 g/day + amikacin 1 g/day + doxycycline 200 mg/day |
7th ⇒ 9th months |
Hospitalization No response, new symptoms |
New nodules formation (subclavian catheter region) |
ESR 104 mm/h, WBC 8800 mm−3, Hb 12.7 g/L, CRP 14.7 mg/dL |
Linezolid 1200 mg/day + doxycycline 200 mg/day |
9th ⇒ 12th months |
Suppression or cure + adverse effects due to linezolid |
Peripheric neuropathy, severe malaise |
ESR 42 mm/h, CRP 1.06 mg/dL |
TMP/SXT 5 mg/kg/day + doxycycline 200 mg/day + B6 vitamin |
12th ⇒ 15th months |
Resolution discharge from hospital (13th month) |
Fluctuating mild cutaneous symptoms |
ESR 26 mm/h, Hb g/L, Ht 39.8, CRP 0.73 mg/dL |
TMP/SXT 5 mg/kg/day + doxycycline 200 mg/day |
15th ⇒ 22nd months |
Resolution and cure |
None |
ESR 10 mm/h, WBC 8080 mm−3, Hb 14.2 g/L, Ht 43.1 CRP 0.3 mg/dL |
TMP/SXT 5 mg/kg/day + doxycycline 200 mg/day |
22nd ⇒ 28th months |
Well-being |