Rhodococcus equi pneumonia in a live related renal transplant recipient

Rhodococcus equi has emerged as a serious pathogen in immunocompromised patients, including 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. Furthermore, in cultures, Rhodococcus can be misinterpreted by microbiologists in laboratories as a contaminant due to its morphology on gram staining if they have not been provided sufficient clinical information. We report a case of a young Asian male, 19 months post-live related renal transplantation who presented with a five-day history of productive cough, fever and weight loss. Chest radiography revealed bilateral basal infiltrates. Blood cultures and bronchoalveolar lavage yielded heavy pure growth of unbranched gram-positive rods which were identified as Rhodococcus equi (R. equi).