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A not so innocuous playground fall: lymphocutaneous nocardiosis in an immunocompetent boy
  1. Phoebe C M Williams1,2,3,
  2. Adam William Bartlett2,3,
  3. Pamela Palasanthiran2,3,
  4. Brendan McMullan2,3
  1. 1School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
  2. 2School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia
  3. 3Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
  1. Correspondence to Dr Phoebe C M Williams, Department of Infectious Diseases and Immunology, Sydney Children's Hospitals, Randwick, NSW 2031, Australia; phoebe.williams{at}

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An otherwise well, fully immunised 9-year-old boy presented due to systemic malaise with an infected knee laceration 10 days after falling onto concrete in his school playground. On examination his growth parameters were age-appropriate; he was febrile to 39.1℃, with purulent exudate oozing from his knee (figure 1). There was evidence of nodular lymphangitis with lymphocutaneous spread (figure 2). Investigations revealed white cell count of 12.2×109/L with mild neutrophilia (9.37×109/L), C reactive protein of 58 mg/L, and his blood culture was negative. Imaging excluded an underlying bone infection.

Figure 1

The …

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  • Twitter @phoebwill

  • Contributors BM conceived the paper. PCMW wrote the first draft. All authors were involved in the management of the patient and reviewed and commented on the manuscript draft and resubmission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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