Abstract
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Meyer DK and Reboli AC (2005) Rhodococcus equi. In Principles and Practice of Infectious Diseases, 2472–2478 (Eds Mandell GL et al.) Philadelphia: Elsevier
Prescott JF et al. (1991) Rhodococcus equi: an animal and human pathogen. Clin Microbiol Rev 4: 20–34
Arya B et al. (2004) Rhodococcus equi pneumonia in a renal transplant patient: a case report and review of literature. Clin Transplant 18: 748–752
Tse KC et al. (2008) Rhodococcus lung abscess complicating kidney transplantation: successful management by combination antibiotic therapy. Transpl Infect Dis 10: 44–47
Gallen F et al. (1999) Pulmonary infection from Rhodococcus equi after renal transplantation: review of the literature [French]. Nephrologie 20: 383–386
Marsh HP et al. (2000) Successful treatment of Rhodococcus equi pulmonary infection in a renal transplant recipient. Ann R Coll Surg Engl 82: 107–108
Szabó B et al. (2000) Isolation of rare opportunistic pathogens in Hungary: case report and short review of the literature. Rhodococcus equi. Acta Microbiol Immunol Hung 47: 9–14
Barsotti M et al. (1997) Sepsis from Rhodococcus equi successfully treated in a kidney transplant recipient. Nephrol Dial Transplant 12: 2002–2004
González-Roncero FM et al. (2002) Medical management of pneumonia caused by Rhodococcus equi in a renal transplant recipient. Am J Kidney Dis 39: E7
La Rocca E et al. (1998) Pulmonary infection caused by Rhodococcus equi in a kidney and pancreas transplant recipient: a case report. Transplantation 65: 1524–1525
Stiles BM et al. (2002) Role of surgery in Rhodococcus equi pulmonary infections. J Infect 45: 59–61
Simsir A et al. (2001) Rhodococcus equi and cytomegalovirus pneumonia in a renal transplant patient: diagnosis by fine-needle aspiration biopsy. Diagn Cytopathol 24: 129–131
Kasiske B et al. (2004) Clinical practice guidelines for managing dyslipidemias in kidney transplant patients: a report from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Am J Transplant 4 (Suppl 7): S13–S53
Holdaas H et al. (2003) Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. Lancet 361: 2024–2031
Westphal JF (2000) Macrolide-induced clinically relevant drug interactions with cytochrome P-450A (CYP) 3A4: an update focused on clarithromycin, azithromycin and dirithromycin. J Clin Pharmacol 50: 285–295
Acknowledgements
The authors would like to thank C Öhlschlegel, K Boggian, W Nagel and W Riesen, all at Cantonal Hospital St Gallen, for their helpful input into this Case Study. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Speck, D., Koneth, I., Diethelm, M. et al. A pulmonary mass caused by Rhodococcus equi infection in a renal transplant recipient. Nat Rev Nephrol 4, 398–403 (2008). https://doi.org/10.1038/ncpneph0833
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpneph0833
