Introduction In endemic countries for tuberculosis (TB), HIV-TB coinfection is very common. However, other bacteria such as Rhodococcus produce similar clinical and radiological changes. Our objective is to report a case of Rhodococcus pneumonia in a HIV patient.
Methods 29 year old male, from Rio de Janeiro, cocaine user. Presented in Mar/16 with productive cough and hemoptysis, high fever, weight loss, sweating, right pleuritic pain and dyspnea. In Apr/16, he was treated for bacterial pneumonia. Symptoms persisted and by the end of May/16, pulmonary TB was suspected. AFB were detected in sputum. GeneXpert test was negative. Chest x-ray showed multiple cavitations in right upper lober. In June/16 RHZE was started. Three days later, he presented with abdominal pain, vomiting and diarrhoea and was hospitalised. RHZE was suspended and HIV diagnosis was made at this time. On admission, he was febrile (38.1°C), tachypneic and pale; crackling rales in the upper 1/3 of the right lung. Liver function tests were normal. RHZE was reintroduced. FBC showed mild anaemia and leukocytosis; normal renal function. Chest x-ray revealed abscesses with thickened walls and an air-fluid level, and extensive consolidation in RUL. Because of the dissociation between sputum smear microscopy and GeneXpert results, rhodococcus infection was suspected and levofloxacin was started. Blood cultures showed growth in 3 samples and Gram staine was suggestive of corynebacteria. Rhodococcus was identified by Coryne API. Chest CT showed ground-glass infiltrate, and sulfamethoxazole-trimethoprim for PCP was initiated. The patient was afebrile after 72 hours of levofloxacin and rifampicin. He was discharged and is currently well, followed at the outpatient unit.
Discussion and conclusion The case was suggestive of TB but was confirmed as Rhodococcus. Because it is rare, it can lead to delayed diagnosis, inadequate therapy and increased mortality. It is important to investigate rodhococcosis in HIV patients with TB criteria, especially in case of dissociation between smear microscopy and GeneXpert.