Disseminated Rhodococcus equi infection in a kidney transplant patient without initial pulmonary involvement

Rhodococcus equi is increasingly recognized as an opportunistic pathogen in solid organ transplant recipients. Primary pulmonary involvement is the most common finding. We report a case of a 42-year-old female kidney transplant recipient who developed multiple disseminated abscesses caused by R. equi while on adequate antimicrobial therapy. The patient presented with subcutaneous abscesses in the hip region and mamma and had 2 intracerebral abscesses. There were no clinical and radiologic signs of pulmonary involvement in contrast to most clinical cases described in the literature. R. equi was cultured from all abscesses. The patient died of progressive neurologic complications. Post mortem examination confirmed infection with R. equi and showed microscopic evidence of necrotizing pneumonia. This report shows that R. equi should be considered as a cause of infection in solid organ transplant recipients even without initial clinical and radiologic signs of pulmonary involvement. Despite adequate therapy, the outcome can be fatal.