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.
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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.
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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
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DOI: https://doi.org/10.1038/ncpneph0833