title: Antibiotic failure in a renal transplant patient with Rhodococcus equi infection: an indication for surgical lobectomy.
abstract: Rhodococcus equi is an animal pathogen that causes infrequent but challenging infections in immunocompromised individuals, few of which have been described in solid organ transplant recipients. Common clinical presentations include indolent cough, fever, and dyspnea, with necrotizing pneumonia and cavitation. We report a case of a dense right upper lung pneumonia with resultant R. equi bacteremia in a renal transplant recipient. Our patient initially responded to antibiotic treatment with resolution of bacteremia and clinical recovery, followed by interval progression in her right upper lobe consolidation on follow-up computed tomography scans. She underwent lobectomy for definitive therapy with resolution of symptoms. Lobectomy can be utilized in isolated infection after antibiotic failure with excellent clinical outcomes.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Baylor University Medical Center, Dallas, Texas, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ursales
authors.forename: J A
authors.initials: JA
authors.lastname: Klein
authors.forename: S G
authors.initials: SG
authors.lastname: Beal
authors.forename: M
authors.initials: M
authors.lastname: Koch
authors.forename: S
authors.initials: S
authors.lastname: Clement-Kruzel
authors.forename: L B
authors.initials: LB
authors.lastname: Melton
authors.forename: C W
authors.initials: CW
authors.lastname: Spak
mesh_terms: D000193:Actinomycetales Infections / Q000188:drug therapy* / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008168:Lung / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008171:Lung Diseases / Q000382:microbiology* / Q000601:surgery; D008875:Middle Aged; D016929:Rhodococcus equi / Q000302:isolation & purification*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents
keywords: Rhodococcus equi; antibiotic therapy; lobectomy; renal transplant; surgical indications