Rhodococcus equi pulmonary infection in a pancreas‐alone transplant recipient: consequence of intense immunosuppression

Abstract

We report the case of a pancreas-alone transplant recipient who developed Rhodococcus equi pneumonia after receiving multiple courses of antilymphocyte therapy for the treatment of recurrent acute pancreas allograft rejection. We also review and discuss the diagnosis, clinical course, and treatment of 18 cases of R. equi infection reported in solid organ transplant recipients. The lung is the most common primary site of infection, but R. equi infection is difficult to diagnose because of the pleomorphic, gram-positive, and partially acid-fast nature of the organism. Treatment usually involves a combination of antibiotics including rifampin, macrolides, vancomycin, and ciprofloxacin. The optimal duration of therapy is unknown, but relapse is common if the duration of treatment is less than 14 days. The duration of therapy should be guided by clinical recovery, culture results, and radiographic findings. Monitoring levels of immunosuppressive agents-such as tacrolimus and cyclosporine-is needed in order to avoid clinically significant drug interactions with rifampin or the macrolides when these agents are used in order to treat R. equi infection in the transplant population.

Persistent Rhodococcus equi infection in a renal transplant patient: case report and review of the literature

“…To date, 39 cases of Rhodococcus infection have been reported in transplant recipients. The characteristics of these cases, including our current case, are summarized in Table . Most transplant‐related R. equi infections occur after renal transplant, in men, at varying times post transplantation.…”

Kidney and Pancreas Transplantation

“…Overall, 47 patients discontinued the study before the 3-month followup was complete. The study [11,36,43,96,121,134,149,156,157,[170][171][172][173][174][175])…”

“…However, there was no comparison group in this study. The Consensus on Neoral C 2 : Expert Review in Transplantation (CONCERT) group has developed guidelines for C 2 monitoring of cyclosporine [149]. Among the recommendations are directives regarding the 15-min "window of opportunity" before and after the 2-h time point that the blood level must be drawn in order to remain within a 10% margin of error.…”

“…Treatment is often with TMP-SMX at highdose and in some cases, with other agents or combinations such as imipenem, linezolid, azithromycin. [148][149][150] and may be associated with horses and farm exposures. Cultures of this organism may be misidentified as "diphtheroids" so clinicians should maintain a high index of suspicion [148].…”

Zoonoses in Solid-Organ and Hematopoietic Stem Cell Transplant Recipients

“…Inhalation Numerous, including pancreas [50], pancreas-kidney [51], heart [52], liver [53], and lung [54] No Horses, swine [75,76] and HSC [77] No Cattle [85] and kidney [86][87][88] No Rodents, cattle…”