Rhodococcus equi and cytomegalovirus pneumonia in a renal transplant patient: Diagnosis by fine-needle aspiration biopsy

Rhodococcus equi is a common cause of pneumonia in animals. Human infection is rare. Increasing number of cases are being reported in immunosuppressed individuals mostly associated with HIV infection, but also in solid organ transplant recipients and leukemia/lymphoma patients. We report on an adult male who developed pneumonia and gastroenteritis 4 mo after receiving a re nal transplant. CT scan of the lungs showed a dominant 2.5-cm upper lobe lu ng mass and smaller bilateral nodules. He underwent a diagnostic bronchosco py with fine-needle aspiration biopsy of the largest lung nodule. Smears sh owed histiocytic granulomatous inflammation, foamy macrophages, and acute i nflammatory exudate. Scattered foamy macrophages displayed intracellular co ccobacilli identifiable no Diff-Quick stain. A few cells with changes sugge stive of viral inclusions were identified. Cytomegalovirus (CMV) immunostai n was positive in the cell block sections. Lung cultures grew R. equi. To t he best of our knowledge, this is the first report of coinfection with R. e qui and CMV. (C) 2001 Wiley-Liss, Inc.