Rhodococcus equi lung infection in an allogeneic hematopoietic stem cell transplant recipient

Area of Science:

• Infectious Diseases
• Hematology
• Transplant Medicine

Background:

• Hematopoietic stem cell transplantation (HSCT) recipients are susceptible to opportunistic infections due to profound immunosuppression.
• Graft-versus-host disease (GVHD) further complicates post-transplant recovery and immune reconstitution.
• Rhodococcus equi is an emerging pathogen in immunocompromised hosts, particularly after HSCT.

Observation:

• A case of Rhodococcus equi lung infection is presented in a patient with an allogeneic HSCT and oral GVHD.
• The infection persisted for approximately 3 months despite vancomycin treatment.
• The patient had decreased humoral and cellular immunity, common post-HSCT.

Findings:

• Successful treatment of refractory Rhodococcus equi lung infection was achieved with a combination of intravenous ertapenem and oral rifampin.
• This combination therapy was administered for 1 month.
• The lung lesion showed a favorable response to the ertapenem and rifampin regimen.

Implications:

• This case highlights the potential for Rhodococcus equi to cause severe lung infections in HSCT recipients.
• Combination antibiotic therapy appears crucial for treating Rhodococcus infections in patients with compromised immune systems.
• Further research into optimal treatment strategies for Rhodococcus infections in transplant recipients is warranted.