Sepsis from Rhodococcus equi successfully treated in a kidney transplant recipient

due to congenital vesico-ureteral reflux. In 1990 haemoAIDS or organ transplant immunodepressed patients dialysis treatment was started and in 1993 he received are susceptible to infectious diseases from weakly a cadaveric renal transplant. Six months later he prepathogenic bacteria. This is the case of infection from sented with a rejection episode treated by prednisone Rhodococcus equi, a Gram-positive aerobic bacterium pulse therapy. Subsequently, renal function was stable with intracellular tropism that is usually present in and serum creatinine ranged from 2.2 to 2.5 mg/dl. stools of horses and in soil [1 ]. In veterinary medicine Chronic immunosuppression was achieved with predit is well known as a pathogen for several mammalians, nisone (10 mg/day), cyclosporine A (175 mg/day) and including horses, cows, and others. Humans are rarely azathioprine (75 mg/day). a ected with the infection limited to immunodepressed One month before admission he presented with fever patients [1]. reaching 39.5°C in the late afternoon and decreasing Rhodococcus equi was first described in 1923 as during the night, with weakness, pain on the left side Corynebacterium equi by Magnusson, who isolated it of the chest with submammary irradiation, and fascicfrom the lungs of 10 foals with pneumonia. The first ulations. Broad spectrum antibiotic and analgesic drug case of human disease from R. equi was reported in therapy were unsuccessful, as well as paravertebral 1967 by Golub et al. who described cavitary pneumonia (D8–D9) injections of steroids and anaesthetic drugs. in a steroid-treated patient a ected by plasma cell A thoracic radiograph revealed an opacity in the mid hepatitis [1 ]. portion of the left lung. Until 1983, only 12 cases of R. equi infection had At admission, we observed a seriously sick patient, been described in humans, eight of them receiving complaining of dyspnea, weakness, chest pain on the immunosuppressive therapy for haematological disleft side, and unproductive cough. Physical examinaeases and four for renal transplantation [2]. In 1986, tion revealed a 3 cm diameter subcutaneous nodule Samies et al. described a case of R. equi infection in a with warm, erythematous skin in the left interscapulopatient with AIDS [3]. During the following years, rachidean region. Breath sound reduction and rales these cases have been reported more frequently due to were detected in the lower area of the left lung. Axillary the increasing number of cases of AIDS and transtemperature was 39°C. planted patients. In the last review of the literature, Biochemistry showed serum creatinine 2.7 mg/dl, Verville et al. reports 72 cases of infectious diseases creatinine clearance 17.3 ml/min, cyclosporinemia from R. equi in humans [4]. More recently, Tang et al. 168 ng/ml, WBC count 4900 (neutrophils 90%), RBC described a R. equi peritonitis in two patients on 3.49×106, haemoglobin 10.9 g/dl, HCT 33%, and continuous ambulatory peritoneal dialysis [5]. platelets 246.000; sGOT 47 U/l, sGPT 29/Ul, and c-GT We report a successfully treated sepsis from 75 U/l. Serum glucose, bilirubin, total cholesterol, triRhodococcus equi in an adult male patient on maintenglycerides, electrolytes, total protein, electrophoresis, ance immunosuppression for renal transplantation. and urine analysis were normal. HIV-Ab, HBV-Ag