Pulmonary Malakoplakia by Rhodococcus equi in an HIV-Infected Patient in Mexico: A Case Report

Abstract

Background. Rhodococcus equi-related pulmonary malakoplakia is a rare condition with few reported cases; hereby, we present a case associated with advanced human immunodeficiency virus (HIV) infection, and thus far to our knowledge, the first report in Mexico. It is estimated that approximately 10% of the infections occur in immunocompetent patients, whereas the rest are immune deficient, targeting virtually any organ. Histologically, malakoplakia is characterized by the buildup of infiltrated inflammatory tissue as a consequence of the gathering of histiocytes embedded with concentric inclusions. The diagnosis relies on the cultures and the susceptibility testing as well as the pathologic findings compatible with the disease. Case Presentation. We present a 25-year-old male patient with persistent nonproductive cough for over a year and with weight loss, who comes to the emergency department with recent fever, swollen and tender lymph nodes, and hemoptysis. The patient gets diagnosed and treated for Rhodococcus equi-related pulmonary malakoplakia. Conclusion. Knowing the involvement of Rhodococcus in HIV is fundamental for the diagnosis and optimal treatment, which although unknown, a combination of antibiotics with intracellular penetration, on-time resection, and a proper immune reconstitution represents the best approach. Prognosis varies with mortality rates from 34% to 54%.

Genomic Characteristics and Pan-Genome Analysis of Rhodococcus equi

“…In AIDS patients, in spite of rapid diagnosis and proper treatment R. equi infection can lead to serious and even life-threatening diseases ( Albert et al., 2021 ). The mortality of AIDS patients with combined R. equi infection was as high as 20%~58% ( Ahumada et al., 2020 ). With the extensive application of antibiotics, reports of multidrug-resistance in R. equi are increasing, including resistance to trimethoprim, sulfamethoxazole, ampicillin sulbactam, clindamycin, erythromycin and rifampicin ( Petry et al., 2020 ; Alvarez-Narvaez et al., 2021a ; Huber et al., 2021 ).…”