Rhodococcus equi infection in transplant recipients -: Case report and review of the literature

Background. Rhodococcus equi is an opportunistic pathogen that usually causes infection in immuno-compromised hosts, mainly human immunodeficiency virus-positive patients, yet solid organ transplant recipients may be affected as well. Infections in this group of patients have not been sufficiently analyzed. Methods. We report an R equi pneumonia in a heart transplant recipient and review another 11 cases. Results. Infection appeared a mean of 49 months (range 1-180) after transplantation. Lung was primarily involved in 10 cases (83.3%). The remaining two cases presented with a paravertebral abscess and a purulent pericarditis. Invasive techniques were necessary to reach the diagnosis in nine cases. One patient healed with surgical resection of the lesion; the remaining 11 received antimicrobial agents. Six of them required additional surgical treatment. Three patients died. Conclusions. Clinicians should consider R equi when evaluating a solid organ recipient with an asymptomatic lung nodule. Microbiology laboratories should be alerted in these cases because it could be mistaken for a contaminant diphtheroid and will not respond to the standard empirical therapy.