SESSION TITLE: Infectious Disease Student/Resident Case Report Posters III
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Rhodococcus equi is a zoonotic organism that can cause a broad spectrum of disease in humans. Primarily, immunocompromised patients are affected and pulmonary involvement is most common.
CASE PRESENTATION: The patient is a 63-year-old female horse farmer with a history of longstanding tobacco abuse who presented with a chief complaint of hemoptysis that had been progressively worse over several months. She also noticed that she was losing weight, about 15 pounds unintentionally in one year. She also endorsed occasional productive cough, sharp chest pain, fatigue, and subjective fevers. A chest x-ray revealed an infiltrate and subsequent CTA showed a left upper lung mass. Plans were made to obtain a tissue sample through EBUS. The biopsies and washings from this bronchoscopy were nondiagnostic. AFB cultures also were negative. She then underwent CT guided biopsy that was inconclusive. Finally, bronchoscopy with navigational biopsy was performed and a specimen was obtained which showed malakoplakia. Cultures were positive for Rhodococcus equi. Extended antibiotic therapy with azithromycin and rifampin was initiated.
DISCUSSION: Rhodococcus equi is present in the feces of many grazing animals and is ubiquitously present in farm soil. It is a well-known veterinary pathogen and a recognized pathogen in immunocompromised patients such as transplant recipients and those with HIV/AIDs. Less than 15% of reported cases occur in immunocompetent individuals. Pulmonary disease is the most common manifestation of infection with Rhodococcus. Combination therapy with two to three antibiotics is a mainstay of treatment. Often, surgery is also required to remove large areas of necrotic tissue.
CONCLUSIONS: Our patient presented with subacute pulmonary symptoms and a lung mass. Multiple biopsy attempts with EBUS, CT guidance, and navigational bronchoscopy were performed before a correct tissue diagnosis could be obtained. While she had extensive exposure to farm soil and horses she is not immunosuppressed which makes her case atypical.
Reference #1: Yamshchikov AV, Schuetz A, Lyon GM. Rhodococcus equi infection. Lancet Infect Dis. 2010;10:350-359.
DISCLOSURE: The following authors have nothing to disclose: Elizabeth Anderson, Jaspal Singh
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