Disseminated Rhodococcus equi infection in a patient with Hodgkin’s lymphoma
Introduction. Rhodococcus (R) equi is an opportunistic, uncommon human pathogen that causes mainly infection in immunocompromised hosts. The disease is usually presented as subacute pneumonia that is mostly cavitary and sometimes bacteremic. Case report. We reported the extremly rare case o...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2014-01-01
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| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501300035M.pdf |
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| Summary: | Introduction. Rhodococcus (R) equi is an opportunistic, uncommon human
pathogen that causes mainly infection in immunocompromised hosts. The disease
is usually presented as subacute pneumonia that is mostly cavitary and
sometimes bacteremic. Case report. We reported the extremly rare case of a
43-year-old woman with Hodgkin's lymphoma, who developed R. equi pulmonary
infection after recieving multiple courses of chemotherapy. Secondary, the
patient developed bacteremia, leading to sepsis and dissemination of R. equi
infection in many extrapulmonary sites. At addmission the patient was
febrile, tachypnoic, tachycardic, hypotensive, with facial edema,
splenomegaly, positive meningeal signs, left hemiparesis and paraparesis.
Laboratory data included erythrocyte sedimentation rate (ESR) > 140 mm/h,
C-reactive protein (CRP) 143.0 mg/L, red blood cells (RBC) 2.14 × 1012/L,
whyite blood cells (WBC) 2.8 × 109/L, lactate dehydrogenase (LDH) 706 U/L,
serum albumin 26 g/L, sodium 127 mmol/L and potassium 2.7 mmol/L. Blood
culture and culture of sputum and empyema were positive for R. equi. Imaging
studies demonstrated a large right cavitary pneumonia and abscess, empyema,
pericarditis, mediastinal and intra-abdominal lymphadenopathy, brain and
psoas abscesses, osteomyelitis and spondylodiscitis. The patient recovered
completely after a 12-month treatment with combinations of parenteral and
oral antibiotics (meropenem, vancomycin, teicoplanin, ciprofloxacin,
rifampicin, macrolides etc), including drainage of abscesses and empyema.
Eight years after completition of the treatment the patient was without
recurrence of R. equi infection and lymphoma. Conclusion. Since the
eradication od R. equi is very difficult, it is very important to make the
diagnosis and initiate appropriate antibiotic therapy as soon as possible. |
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| ISSN: | 0042-8450 |