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Open Access Case report

Disseminated rhodococcus equi infection in HIV infection despite highly active antiretroviral therapy

Francesca Ferretti1*, Antonio Boschini2, Cristiana Iabichino3, Simonetta Gerevini4, Paola De Nardi5, Monica Guffanti1, Giuseppe Balconi3, Adriano Lazzarin1 and Paola Cinque1

Author Affiliations

1 Department of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy

2 San Patrignano Medical Center, Rimini, Italy

3 Department of Radiology, San Raffaele Scientific Institute, Milano, Italy

4 Head and Neck Department, San Raffaele Scientific Institute, Milano, Italy

5 Department of Surgery, San Raffaele Scientific Institute, Milano, Italy

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BMC Infectious Diseases 2011, 11:343  doi:10.1186/1471-2334-11-343

Published: 14 December 2011

Abstract

Background

Rhodococcus equi (R.equi) is an acid fast, GRAM + coccobacillus, which is widespread in the soil and causes pulmonary and extrapulmonary infections in immunocompromised people. In the context of HIV infection, R.equi infection (rhodococcosis) is regarded as an opportunistic disease, and its outcome is influenced by highly active antiretroviral therapy (HAART).

Case presentation

We report two cases of HIV-related rhodococcosis that disseminated despite suppressive HAART and anti-rhodococcal treatment; in both cases there was no immunological recovery, with CD4+ cells count below 200/μL. In the first case, pulmonary rhodococcosis presented 6 months after initiation of HAART, and was followed by an extracerebral intracranial and a cerebral rhodococcal abscess 1 and 8 months, respectively, after onset of pulmonary infection. The second case was characterized by a protracted course with spread of infection to various organs, including subcutaneous tissue, skin, colon and other intra-abdominal tissues, and central nervous system; the spread started 4 years after clinical resolution of a first pulmonary manifestation and progressed over a period of 2 years.

Conclusions

Our report highlights the importance of an effective immune recovery, despite fully suppressive HAART, along with anti-rhodococcal therapy, in order to clear rhodococcal infection.