SevereRhodococcus equi pneumonia: Case report and literature review

Rhodococcus equi is an aerobic, gram-positive, non-motile pleomorphic bacillus infecting immunocompromized patients. Forty-nine cases ofRhodococcus equi infection have been reported, mainly in patients infected with the human immunodeficiency virns (HIV). A case in whichRhodococcus equi eaused severe pulmonary infection, the most common presentation, is described. Clinically, patients have symptoms of pneumonia with hemoptysis as a prominent feature. X-ray will often show a cavitating upperlobe infiltrate, resembling infection with mycobacteria.Rhodococcus equi is easily cultured from blood or sputum on standard media, but is frequently regarded as a contaminant. Mortality fromRhodococcus equi pneumonia is high (25 %) and early surgical intervention has been recommended. Based on this review, the benefit of surgery seems dubious, whereas good results have been obtained using long-term antibiotic treatment with erythromycin plus rifampicin, or vancomycin in combination with either of these antibiotics.