Liang GF, Chao S, Sun Z, Zhu KJ, Chen Q, Jia L, Niu YL. Pleural empyema with endobronchial mass due to Rhodococcus equi infection after renal transplantation: A case report and review of literature. World J Clin Cases 2024; 12(1): 224-231 [PMID: 38292625 DOI: 10.12998/wjcc.v12.i1.224]
Corresponding Author of This Article
Yu-Lin Niu, PhD, Chief Physician, Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Beijing Road, Yunyan District, Guiyang 550000, Guizhou Province, China. niuyulin@gmc.edu.cn
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Guo-Fu Liang, Zhou Sun, Department of Organ Transplantation, School of Clinical Medicine, Guizhou Medical University, Guiyang 550025, Guizhou Province, China
Sheng Chao, Ke-Jing Zhu, Qian Chen, Lei Jia, Yu-Lin Niu, Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
Author contributions: Liang GF and Niu YL wrote and collated the manuscript; Chao S and Sun Z collected and collated patient data; Liang GF, Chao S, Sun Z, Zhu KJ, Chen Q, Jia L, and Niu YL reviewed and received funding for the manuscript; and all authors have read and approved the final manuscript.
Supported byScience and Technology Project of Guizhou Province, No. ZK[2023]380.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Lin Niu, PhD, Chief Physician, Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Beijing Road, Yunyan District, Guiyang 550000, Guizhou Province, China. niuyulin@gmc.edu.cn
Received: November 5, 2023 Peer-review started: November 5, 2023 First decision: November 22, 2023 Revised: November 30, 2023 Accepted: December 20, 2023 Article in press: December 20, 2023 Published online: January 6, 2024 Processing time: 57 Days and 19.1 Hours
Abstract
BACKGROUND
Kidney transplantation is the best option for patients with end-stage renal disease. However, the need for lifelong immunosuppression results in renal transplant recipients being susceptible to various infections. Rhodococcus equi (R. equi) is a rare opportunistic pathogen in humans, and there are limited reports of infection with R. equi in post-renal transplant recipients and no uniform standard of treatment. This article reports on the diagnosis and treatment of a renal transplant recipient infected with R. equi 21 mo postoperatively and summarizes the characteristics of infection with R. equi after renal transplantation, along with a detailed review of the literature.
CASE SUMMARY
Here, we present the case of a 25-year-old man who was infected with R. equi 21 mo after renal transplantation. Although the clinical features at the time of presentation were not specific, chest computed tomography (CT) showed a large volume of pus in the right thoracic cavity and right middle lung atelectasis, and fiberoptic bronchoscopy showed an endobronchial mass in the right middle and lower lobe orifices. Bacterial culture and metagenomic next-generation sequencing sequencing of the pus were suggestive of R. equi infection. The immunosuppressive drugs were immediately suspended and intravenous vancomycin and azithromycin were administered, along with adequate drainage of the abscess. The endobronchial mass was then resected. After the patient’s clinical symptoms and chest CT presentation resolved, he was switched to intravenous ciprofloxacin and azithromycin, followed by oral ciprofloxacin and azithromycin. The patient was re-hospitalized 2 wk after discharge for recurrence of R. equi infection. He recovered after another round of adequate abscess drainage and intravenous ciprofloxacin and azithromycin.
CONCLUSION
Infection with R. equi in renal transplant recipients is rare and complex, and the clinical presentation lacks specificity. Elaborate antibiotic therapy is required, and adequate abscess drainage and surgical excision are necessary. Given the recurrent nature of R. equi, patients need to be followed-up closely.
Core Tip: Infection with Rhodococcus equi (R. equi) is rare in renal transplant recipients. To date, no cases of pleural empyema and endobronchial mass have been reported in renal transplant recipients infected with R. equi. We report the diagnosis and management of a renal transplant recipient infected with R. equi at 21 mo postoperatively and incorporate a review of the literature to illustrate the characteristics of R. equi infection in renal transplant recipients.
