title: Rhodococcus fasciansinfection after haematopoietic cell transplantation: not just a plant pathogen?
abstract: BACKGROUND
  Rhodococcusspp. have been implicated in a variety of infections in immunocompromised and immunocompetent hosts.Rhodococcus equiis responsible for the majority of reported cases, butRhodococcus erythropolis,RhodococcusgordoniaeandRhodococcusruberinfections have been described. There are no prior reports of human infection withRhodococcus fascians.
  
  
  METHODS
  We describe the unexpected finding ofR. fasciansin liver lesions incidentally noted at autopsy in an immunosuppressed patient status after bone-marrow transplant for acute lymphoblastic leukaemia who died of unrelated causes (septic shock due toClostridium difficilecolitis). At autopsy, an otherwise unremarkable liver contained several dozen well-demarcated sclerotic-appearing lesions measuring 0.1-0.3 cm in size. The absence of other bacterial or fungal DNA in the setting of histologically visible organisms argues against its presence as a contaminant and raises the consideration thatR. fasciansrepresents a human pathogen for the immunocompromised.
  
  
  CONCLUSIONS
  Whether it represents the sole infectious agent responsible for the miliary lesions or a partially treated co-infection is impossible to determine, but our finding continues to reinforce the importance of molecular techniques in associating organisms with sites of infection and optimizing treatment of infectious diseases.
authors.affiliation: Department of Pathology, Walter Reed National Military Medical Center , 8901 Rockville Pike, Bethesda, MD 20889 , USA.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Austin
authors.affiliation: Departments of Pulmonary and Critical Care Medicine, University of Washington , 1959 NE Pacific St, Seattle, WA 98105 , USA.
authors.forename: Teal S
authors.initials: TS
authors.lastname: Hallstrand
authors.affiliation: Department of Laboratory Medicine, University of Washington , 1959 NE Pacific St, Seattle, WA 98105 , USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Hoogestraat
authors.affiliation: Department of Radiology, Swedish Medical Center , 5300 Tallman Ave NW, Seattle, WA 98107 , USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Balmforth
authors.affiliation: Department of Laboratory Medicine, University of Washington , 1959 NE Pacific St, Seattle, WA 98105 , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Stephens
authors.affiliation: Department of Laboratory Medicine, University of Washington , 1959 NE Pacific St, Seattle, WA 98105 , USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Butler-Wu
authors.affiliation: Department of Anatomic Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA 98105, USA; Fred Hutchinson Cancer Research Center, 1100 Fairview ave N, Mailstop G7-910, Seattle, WA 98109, USA.
authors.forename: Cecilia C S
authors.initials: CC
authors.lastname: Yeung
keywords: Immunocompromised hosts; Rhodococcus fascians; opportunistic infection; post-transplant complication