Surgical management of Rhodococcus induced anterior mediastinal mass: A case report

Rhodococcus is an extremely rare, gram positive, aerobic, coccobacillary organism, usually found in the soil or in dairy and livestock animals. It is most commonly affecting the immunocompromised. Only 15 % of cases have been reported in immunocompetent hosts.

We bring forth the unusual case of a 45-year-old gem minor who had already undergone pericardial window due to pericardial effusion. He presented to us with recurrent pericardial effusion and anterior mediastinal mass diagnosed on Computed Tomography Pulmonary Angiogram scan. He was diagnosed with Rhodococcus as being the causative organism of the condition on pericardial fluid cultures. This is an extremely rare manifestation of Rhodococcus infection, which has not yet been reported in literature to the best of our knowledge.

The first human case of Rhodococcus was reported in a young male upon steroidal therapy for autoimmune hepatitis who developed pneumonia in 1967. Rhodococci infections are usually common in immunocompromised hosts, and only 19 cases have been reported in immunocompetent hosts till now. The usual signs of presentation are cough, pleuritic chest pain, and fever; however, it varies according to the site of infection. The most common manifestation is pneumonia, although other presentations include osteomyelitis, brain abscess, wound infections, etc.

The diagnosis and treatment of Rhodococci is very difficult due to the rarity of presentation. Despite that, surgical intervention should be considered as the preferred modality for diagnostic purposes and in infections resistant to medical management.