Pulmonary infection with Rhodococcus equi after renal transplantation. Review of the literature.

Rhodococcus Equi, a stictly aerobic Gram positive cocco-bacillus, is a path ogen for horses and foals. It may induce opportunistic infections and is de scribed in AIDS infected patients. We report the case of a 47-year old man, breeder of horses,with kidney tran splant who has presented, 8 years after his graft, an impairment of health, a fever and evidence of pulmonary disease. The pulmonary biopsy under scan ner guidance and microbiology study, has displayed the diagnosis of Rhodoco ccus equi infection. The evolution has been favorable with double antibioth erapy (follow-up 27 months). Ten comparable observations have been published after organ transplantation : (kidney: 8; heart: 1; liver: 1). Pulmonary locations are widely predomina nt. The animal contact is found only in 30% of cases. The presentation of t he sickness has been compared to pulmonary tuberculosis or to nocardiosis, pathologies often observed in this context of immunosuppression. The antibiotic treatment is difficult and should required two bactericidal antibiotics A surgical lobectomy can be envisaged in case of relapse. The m ortality is 30%.