ABSTRACT BACKGROUND A 62-year-old male kidney transplant recipient was admitted to hospital with a 14-day history of fever, hemoptysis and left-sided pleuritic chest pain. He had suffered

malaise, weight loss, night sweats and exertional dyspnea over the previous 3 months. Imaging studies of the patient's chest revealed a noncavitated mass measuring 5 × 8 cm in the

anterior segment of the left upper lobe of the lung and a left-sided pleural effusion with septa, and bacterial cultures revealed the presence of _Rhodococcus equi_. INVESTIGATIONS Physical

examination, laboratory tests, chest X-ray, CT scan of the chest, bronchoscopy, and bacterial culture of blood, sputum, bronchoalveolar lavage fluid and pleural fluid. DIAGNOSIS _R. equi_

immunosuppressive therapy. Following the diagnosis of myopathy, simvastatin was discontinued. Access through your institution Buy or subscribe This is a preview of subscription content,

access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and online access $209.00 per year only $17.42 per issue Learn

more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS

OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support REFERENCES * Meyer DK and Reboli AC (2005) _Rhodococcus equi_. In _Principles and

Practice of Infectious Diseases_, 2472–2478 (Eds Mandell GL _ et al_.) Philadelphia: Elsevier Google Scholar  * Prescott JF _ et al_. (1991) _Rhodococcus equi_: an animal and human pathogen.

_Clin Microbiol Rev_ 4: 20–34 Article  CAS  PubMed  PubMed Central  Google Scholar  * Arya B _ et al_. (2004) _Rhodococcus equi_ pneumonia in a renal transplant patient: a case report and

review of literature. _Clin Transplant_ 18: 748–752 Article  PubMed  Google Scholar  * Tse KC _ et al_. (2008) _Rhodococcus_ lung abscess complicating kidney transplantation: successful

management by combination antibiotic therapy. _Transpl Infect Dis_ 10: 44–47 Article  CAS  PubMed  Google Scholar  * Gallen F _ et al_. (1999) Pulmonary infection from _Rhodococcus equi_

after renal transplantation: review of the literature [French]. _Nephrologie_ 20: 383–386 CAS  PubMed  Google Scholar  * Marsh HP _ et al_. (2000) Successful treatment of _Rhodococcus equi_

pulmonary infection in a renal transplant recipient. _Ann R Coll Surg Engl_ 82: 107–108 CAS  PubMed  PubMed Central  Google Scholar  * Szabó B _ et al_. (2000) Isolation of rare

opportunistic pathogens in Hungary: case report and short review of the literature. _Rhodococcus equi. Acta Microbiol Immunol Hung_ 47: 9–14 PubMed  Google Scholar  * Barsotti M _ et al_.

(1997) Sepsis from _Rhodococcus equi_ successfully treated in a kidney transplant recipient. _Nephrol Dial Transplant_ 12: 2002–2004 Article  CAS  PubMed  Google Scholar  * González-Roncero

FM _ et al_. (2002) Medical management of pneumonia caused by _Rhodococcus equi_ in a renal transplant recipient. _Am J Kidney Dis_ 39: E7 Article  PubMed  Google Scholar  * La Rocca E _ et

al_. (1998) Pulmonary infection caused by _Rhodococcus equi_ in a kidney and pancreas transplant recipient: a case report. _Transplantation_ 65: 1524–1525 Article  CAS  PubMed  Google

Scholar  * Stiles BM _ et al_. (2002) Role of surgery in _Rhodococcus equi_ pulmonary infections. _J Infect_ 45: 59–61 Article  CAS  PubMed  Google Scholar  * Simsir A _ et al_. (2001)

_Rhodococcus equi_ and cytomegalovirus pneumonia in a renal transplant patient: diagnosis by fine-needle aspiration biopsy. _Diagn Cytopathol_ 24: 129–131 Article  CAS  PubMed  Google

Scholar  * Kasiske B _ et al_. (2004) Clinical practice guidelines for managing dyslipidemias in kidney transplant patients: a report from the Managing Dyslipidemias in Chronic Kidney

Disease Work Group of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. _Am J Transplant_ 4 (Suppl 7): S13–S53 Article  Google Scholar  * Holdaas H _ et al_. (2003)

Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. _Lancet_ 361: 2024–2031 Article  CAS  PubMed  Google Scholar  *

Westphal JF (2000) Macrolide-induced clinically relevant drug interactions with cytochrome P-450A (CYP) 3A4: an update focused on clarithromycin, azithromycin and dirithromycin. _J Clin

Pharmacol_ 50: 285–295 Article  CAS  Google Scholar  Download references ACKNOWLEDGEMENTS The authors would like to thank C Öhlschlegel, K Boggian, W Nagel and W Riesen, all at Cantonal

Hospital St Gallen, for their helpful input into this Case Study. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the

learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * D

Speck is a Fellow in Internal Medicine in the Department of Medicine, I Koneth is a Chief Resident in the Division of Nephrology, M Diethelm is Chief Physician of Internal Medicine in the

Department of Medicine and I Binet is Head of the Division of Nephrology, all at Cantonal Hospital St Gallen, St Gallen, Switzerland., Dorothee Speck, Irene Koneth, Markus Diethelm & 

Isabelle Binet Authors * Dorothee Speck View author publications You can also search for this author inPubMed Google Scholar * Irene Koneth View author publications You can also search for

this author inPubMed Google Scholar * Markus Diethelm View author publications You can also search for this author inPubMed Google Scholar * Isabelle Binet View author publications You can

also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Irene Koneth. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing financial

interests. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Speck, D., Koneth, I., Diethelm, M. _et al._ A pulmonary mass caused by _Rhodococcus equi_

infection in a renal transplant recipient. _Nat Rev Nephrol_ 4, 398–403 (2008). https://doi.org/10.1038/ncpneph0833 Download citation * Received: 14 January 2008 * Accepted: 04 April 2008 *

Published: 27 May 2008 * Issue Date: July 2008 * DOI: https://doi.org/10.1038/ncpneph0833 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get

shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative