Empyema with malakoplakic-like lesions by Rhodococcus equi as a presentation of HIV infection

Rhodococcus equi (Corynebacterium equi) is an aerobic actinomycetes, well described as a cause of pulmonary infection in different animals as horses, pigs and cows. This pathogen has a coccobacillar aspect and a variable acid-fast stain in tissues. Rare cases of human infection by Rhodococcus species were described, the majority by Rhodococcus equi, especially in patients with immunodeficiency syndrome (AIDS) in advanced stages of the disease. Usually the diagnosis of infections by Rhodococcus species is performed by positive blood or bronchoalveolar lavage cultures. Here we described a case of a pleuro-pulmonary infection by Rhodococcus equi, with malakoplakic-like lesions, that was the first manifestation of AIDS, whose diagnosis was performed by pleural biopsy (acid-fast bacteria with a variable coccobacillar aspect inside macrophages) and pleural fluid culture.