A pulmonary mass caused by Rhodococcus equi infection in a renal transplant recipient.
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 x 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.


METHODS
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.


METHODS
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.


RESULTS
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.
Speck
Dorothee
D
Department of Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland.
Koneth
Irene
I
Diethelm
Markus
M
Binet
Isabelle
I
D000193:Actinomycetales Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016929:Rhodococcus equi / Q000302:isolation & purification*; D013183:Sputum / Q000382:microbiology; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents