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A pulmonary mass caused by Rhodococcus equi infection in a renal transplant recipient
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A pulmonary mass caused by Rhodococcus equi infection in a renal transplant recipient
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Journal Article
A pulmonary mass caused by Rhodococcus equi infection in a renal transplant recipient
2008
Overview
Rhodococcus equi
is an animal pathogen that sometimes causes opportunistic infections in immunocompromised patients. Speck
et al
. present the case of a 62-year-old male renal transplant recipient who presented with fever, hemoptysis and left-sided pleuritic chest pain. After numerous investigations, a diagnosis of
R. equi
infection with bacteremic pleuropneumonia and pseudotumor was made. This Case Study describes the diagnosis and management of
R. equi
infection, which has a very varied clinical presentation in humans.
Background
A 62-year-old male kidney transplant recipient was admitted to hospital with a 14-day history of fever, hemoptysis and left-sided pleuritic chest pain. He had suffered malaise, weight loss, night sweats and exertional dyspnea over the previous 3 months. Imaging studies of the patient's chest revealed a noncavitated mass measuring 5 × 8 cm in the anterior segment of the left upper lobe of the lung and a left-sided pleural effusion with septa, and bacterial cultures revealed the presence of
Rhodococcus equi
.
Investigations
Physical examination, laboratory tests, chest X-ray, CT scan of the chest, bronchoscopy, and bacterial culture of blood, sputum, bronchoalveolar lavage fluid and pleural fluid.
Diagnosis
R. equi
infection with bacteremic pleuropneumonia and pseudotumor. A secondary myopathy occurred 6 months after diagnosis of the infection as a result of a drug interaction between clarithromycin and simvastatin.
Management
Long-term combination antibiotic therapy (ciprofloxacin plus vancomycin or clarithromycin), resection of the inflammatory pseudotumor, and reduction of immunosuppressive therapy. Following the diagnosis of myopathy, simvastatin was discontinued.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
Actinomycetales Infections - diagnosis
/ Actinomycetales Infections - drug therapy
/ Actinomycetales Infections - microbiology
/ Anti-Bacterial Agents - therapeutic use
/ Biopsy
/ Blood
/ Bronchoalveolar Lavage Fluid - microbiology
/ Complications and side effects
/ Dyspnea
/ Fever
/ Humans
/ Kidney Transplantation - adverse effects
/ Kidneys
/ Lavage
/ Male
/ Medicine
/ Patients
/ Pneumonia, Bacterial - diagnosis
/ Pneumonia, Bacterial - drug therapy
/ Pneumonia, Bacterial - microbiology
