Rhodococcus equi Pneumonia in Kidney Transplant Recipient Affected by Acute Intermittent Porphyria: A Case Report

F. Fontana,S. Scarlini,G. Guaraldi,P. Ventura,E. Franceschini,G. Cappelli,M. Marcacci,M. Codeluppi,G. Ligabue,G. Alfano,C. Mussini

doi:10.1016/j.transproceed.2018.02.213

F. Fontana, S. Scarlini + Show 9 more

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https://doi.org/10.1016/j.transproceed.2018.02.213

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Abstract

Rhodococcus equi is a gram-positive coccobacillus responsible for severe infections in patients with weakened immune systems. R equi generally causes pnumonia that may evolve into fatal systemic infection if left untreated. Here, we present a case of a 67-year-old woman affected by acute intermittent porphyria (AIP) who developed R equi pneumonia 7 months after kidney transplantation. Although clinical features at presentation were nonspecific, lung computed tomography showed right perihilar consolidation with a mass-like appearance causing bronchial obstruction. Appropriate antibiotic including intravenous meropenem and oral azithromycin that was then switched to oral levofloxacin and oral azithromycin along with reduction of immunosuppressive therapy resolved pneumonia without provoking an acute attack of porphyria. AIP limited the choice of antibiotics for the treatment of R equi infection because some potentially porphyrinogenic antibacterial agents were avoided. Based on this experience, azithromycin and meropenem can be safely administered for the treatment of R Equi infection in patients with AIP.

Highlights

Rhodococcus equi is a gram-positive coccobacillus responsible for severe infections in patients with weakened immune systems
We report a case of pneumonia due to R equi infection in a kidney transplant recipient affected by acute intermittent porphyria (AIP)
Fourteen months after the premature discontinuation of the antibiotic therapy, the patient remained asymptomatic, without developing any respiratory diseases or evidence of recurrence on chest radiography. She preserved a stable graft function with a creatinine of 1.9 mg/dL and continued an immunosuppressive regimen based on TAC and methylprednisolone (4 mg once daily). This case illustrates the complex management of R equi pneumonia in a kidney transplant recipient affected by AIP

Summary

CASE DESCRIPTION

A 67-year-old woman affected by AIP presented with nonproductive cough lasting more than 6 weeks (Fig 1). Urinary excretion of porphobilinogen steadily elevated over time, but she did not experience other acute attacks of AIP She was a nonsmoker with an unremarkable history of pulmonary disease. Fourteen months after the premature discontinuation of the antibiotic therapy, the patient remained asymptomatic, without developing any respiratory diseases or evidence of recurrence on chest radiography. She preserved a stable graft function with a creatinine of 1.9 mg/dL (estimated glomerular filtration rate, 25 mL/min [5]) and continued an immunosuppressive regimen based on TAC (target TTL, 6e7.5 mg/dL) and methylprednisolone (4 mg once daily)

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