Pulmonary malakoplakia due to Prescottella (Rhodococcus) soli in a renal transplant recipient: First reported case

Prescottella (Rhodococcus) soli is a soil-dwelling organism not previously thought to be pathogenic in humans. We discuss the case of a 78-year-old male renal transplant recipient presenting with respiratory symptoms and multiple pulmonary nodules, found to be pulmonary malakoplakia secondary to infection with Prescottella (Rhodococcus) soli. Treatment was commenced with vancomycin, meropenem and azithromycin for an induction period of two weeks and continued with indefinite oral moxifloxacin and azithromycin with significant clinical improvement. Although rare, Prescottella species, including Prescottella soli, should be considered in the differential diagnosis of pulmonary nodules, particularly in immunocompromised patients. More data is required to inform optimal treatment.