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Case reports: pericarditis and lymphadenitis due to Rhodococcus equi
T Lee-Chiong1, M Sadigh, M Simms
1Department of Internal Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA.
The American Journal of the Medical Sciences
|July 1, 1995
Summary
Rhodococcus equi infections often affect immunocompromised individuals. This study highlights two unique cases, including the first reported pericarditis and an unusual infection in an immunocompetent patient, emphasizing diagnostic challenges.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Pathology
Background:
- Rhodococcus equi infections typically occur in immunocompromised patients, often presenting with pulmonary disease.
- Diagnosis can be challenging due to the organism's resemblance to diphtheroids and mycobacteria on smears, leading to potential misidentification or dismissal as contaminants.
- The clinical presentation and diagnostic difficulties associated with R. equi warrant further investigation.
Observation:
- Two distinct cases of R. equi infection were observed: pericarditis in a renal transplant recipient and axillary lymphadenitis in an asymptomatic individual.
- The patient with R. equi pericarditis represents the first documented case of this specific manifestation.
- The patient with R. equi lymphadenitis was notably immunocompetent, challenging the typical understanding of risk factors.
Findings:
- Rhodococcus equi can cause rare but severe infections, such as pericarditis, even in patients with significant medical histories like renal transplants.
- The organism's morphologic similarity to other bacteria can lead to diagnostic delays or errors.
- Infection by R. equi is possible in immunocompetent individuals, suggesting broader susceptibility than previously assumed.
Implications:
- Early and accurate diagnosis of R. equi infections is crucial, requiring awareness of its varied presentations and potential for misidentification.
- Clinicians should consider R. equi in the differential diagnosis of infections, particularly in immunocompromised patients but also in immunocompetent individuals presenting with unusual symptoms.
- These cases expand the known spectrum of R. equi disease and underscore the importance of microbiological identification for appropriate patient management.