Rhodococcus equi infection during treatment of a C-ANCA positive vasculitis: a case report

Abstract

Rhodococcus equi is a rare form of opportunistic infection in humans, more common in the immunocompromised. We present a case of pulmonary infection and subsequent cerebral abscess secondary to R. equi in a patient receiving immunosuppression for a c-ANCA positive vasculitis. Heightened awareness of R. equi infection is important when considering immunocompromised patients presenting with sepsis, especially those with cavitating pulmonary lesions and normal respiratory commensals on culture. Delays in diagnosis and treatment can cause increased patient morbidity and mortality.

Cavitary Pulmonary Disease

“…Infection occurs primarily through inhalation (274), although infection may also be acquired by ingestion or traumatic inoculation (376). R. equi is increasingly being recognized as a human pathogen, particularly in those with advanced human immunodeficiency virus infection (CD4 ϩ T-lymphocyte count of Ͻ200 cells/mm 3 ) (133, 385), hematologic malignancies (223), and use of chronic corticosteroids and other immunosuppressive agents (120) and in recipients of solid-organ and stem cell transplants (79,205,268,297). Depending on the series, up to 10 to 15% of cases occur in immunocompetent individuals (118,181,376).…”

Primary retroperitoneal abscesses due to Rhodococcus equi in a patient with severe nephrotic syndrome: successful antibiotic treatment with linezolid and tigecycline

“…equi has become increasingly recognized as a cause of severe infections in immunocompromised patients without HIV disease. [5][6][7] The infection mortality rate is still high (20-25%) 12 and disease relapses are common. 13 A wide range of clinical manifestations have been reported, although pneumonia is present in about 80% of R. equi infections.…”

“…However R. equi infections are increasingly reported in transplant recipients and in patients receiving immunosuppressive and/or prolonged corticosteroid treatment. [5][6][7] The first site of infection is commonly the lung, and it results in a necrotizing pneumonia (80% of cases), which clinically resembles mycobacterial, fungal or nocardial pulmonary infections. 2 Primary extrapulmonary manifestations are unusual and mainly secondary to hematogenous dissemination from a silent lung infection.…”

Avaliação de uma nova estratégia vacinal para a prevenção da Rodococose equina

“…Além disso, o diagnóstico de infecção por R. equi é dificultado devido ao crescimento lento do bacilo e as suas similaridades com outros microorganismos (Garthwaite et al, 2007).…”