BACKGROUND:Nocardiosis is an uncommon disease, and the primary skin infection is usually at the site of a recent injury. Nocardia is a saprophytic bacterium of the soil belonging to the order Actinomycetales. CASE:A 68-year-old woman presented with a painful, hard, dark reddish lesion located in the right hemivulva. She had been treated by radiotherapy for a vulvar leiomyosarcoma arising from the left Bartholin gland at the age of 45. Pathology results demonstrated nocardial infection, initially advanced despite antibiotic therapy. The necrosis extended to and involved the ischiopubic bone, requiring extensive surgical treatment. We performed a radical vulvectomy with partial pubic bone excision to remove the necrotic tissue. A transverse gracilis-myocutaneous free flap was used for vulvar reconstruction. Wound necrosis recurrence required a rectus abdominis myocutaneous flap reconstruction, with an excellent final result. CONCLUSION:This is the first report of primary vulvar nocardiosis. This infection may simulate advanced vulvar carcinoma requiring extensive surgical treatment.