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Acute necrotic somatitis “NOMA” associated with Methicillin-resistant Staphylococcus aureus in a newly acquired rhesus macaque (Macaca mulatta) Jae-il Lee1, Kang-Seok Kim1, Nan-A Kim1, Byung-Cheol Oh1, Il-Hwan Kim4, Chung-Gyu Park1,3*, Sang-Joon Kim1,2 1 Xenotransplantation Research Center, Seoul National University Hospital, Seoul, South Korea Department of Surgery, Seoul National University Hospital, Seoul, South Korea 3 Department of Microbiology and Immunology, Seoul National University Hospital, Seoul, South Korea 4 Drug Evaluation Laboratory, Daewoong R&D Center, Samgye-Ri, Pogok-Myon, Yongin, Kyunggi-Do, South Korea 2 Abstract A newly acquired rhesus macaque was suffering from rapid destruction by necrotizing somatitis on the left cheek. Self-injury by the affected monkey accelerated acute progressive lesion and caused the loss of structural and functional cheek pouch. Immediately after isolation from other monkeys, physical examination, lab work, microorganism culture, and antibiotic susceptibility test were performed. For the restoration, reconstructive surgery and intensive care including antibiotics, wound protector, wound healing agents, debridement were applied. Staphylococcus aureus and Enterococcus faecalis were isolated from the culture of the lesion. Antibiotic susceptibility test revealed Methicillin-resistant Staphylococus aureus infection. Vancomycin and ampicillinsulbactam were effective regimen as antibiotic treatment and also reconstructive surgery was performed following negative result of bacterial culture. rhEGF accelerated the wound healing process and it’s topical application had favorable effect on the noma lesion. Simian noma associated with Methicillin-resistant Staphylococcus aureus has not been reported in nonhuman primate so far. Although this disease is hard to cure for rapid and destructive progress, aggressive treatments led to successful restoration of acute necrotic somatitis lesion in the rhesus macaque. Keywords: MRSA, noma, rhesus macaque, enterococcus feacalis, rhEGF