Abstract: PUB667
Pulmonary Necrotic Rhodococcus equi Infection in a Kidney Pancreas Transplant Recipient: A Rare Case Treated Without Surgical Intervention
Session Information
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Omar, Khawaja O., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Taber, Tim E., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Yaqub, Muhammad S., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Adebiyi, Oluwafisayo O., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Sharfuddin, Asif A., Indiana University School of Medicine, Indianapolis, Indiana, United States
Introduction
Rhodococcus equi has emerged as a serious pathogen in solid organ transplant recipients. Primary pulmonary involvement is the most common presentation. However, this opportunistic pathogen is often not considered in the differential diagnosis of pneumonia in transplant recipients. Approximately less than 30 cases in renal transplants and only 2 in pancreas transplants have been reported with up to 20-25% mortality.
Case Description
57-year-old white male who had received his 3rd renal transplant 2 years and 1st pancreas transplant 12 years earlier. At the time of presentation, he was on tacrolimus, mycophenolate mofetil, prednisone and basiliximab for immunosuppression.He presented with a 2 month history of a cough and weight loss. He had been prescribed azithromycin, doxycycline, and ciprofloxacin by his local providers with no improvement. Chest x-ray showed necortic 5cm cavitary right middle lobe lung lesion . On evaluation he was positive for influenza virus, corona virus and aspergillus.
Bronchoscopy with BAL and lymph node biopsy cultures showed Rhodococcus Equi. He was started on IV vancomycin, meropenem for 6 weeks and his symptoms improved. He was switched to oral azithromycin and linezolid for another 6 months which was later held for cytopenias. He was then given minocycline after 6 months, while the azithromycin prophylaxis was continued. He was also given voriconazole for his aspergilllus for 12 months.Repeat chest imaging near total improvement in the cavitary lesion and his symptoms resolved over the next 6-9 months. Although surgery was considered an option, due the pericardial location of the lesion it was not pursued. His immunosuppressants were reduced and basiliximab was stopped. His creatinine remained stable around 2.4. Over the following year his pancreas function experienced elevation of lipase which was successfully reversed with steroids and resuming his mycophenolate.
Discussion
R.equi is a unique Acid fast positive cocci and a intracellular pathogen. Here we report a very rare case of Rhodococcus infection in a kidney pancreas transplant recipient which was successfully treated without surgical intervention. Choice of antibiotics were challenging while maintaining dual organ transplant function and avoiding acute rejection.