CASE REPORT: PULMONARY MUCORMYCOSIS AND RHODOCOCCOSIS IN A RENAL TRANSPLANT PATIENT

Authors

  • Cindy Alves de Queiroz
  • Alessandra Vaz Kisner
  • Hiulli Maria Duarte Pereira
  • Viviane Nunes Ribeiro
  • Karine Almeida Foletto
  • Amanda Refosco Batista

DOI:

https://doi.org/10.56238/revgeov17n2-052

Keywords:

Mucormycosis, Rhodococcus Infections, Kidney Transplantation, Opportunistic Infections, Coinfection, Immunocompromised Host

Abstract

Pulmonary mucormycosis is a rare, rapidly progressive, and often fatal opportunistic fungal infection, especially in immunocompromised patients. Rhodococcus equi, in turn, is an intracellular opportunistic bacterial pathogen that is uncommon in humans, but shows higher prevalence in kidney transplant recipients. We report the case of a 76-year-old male patient, 15 months post-renal transplantation, under immunosuppressive therapy. The clinical course was marked by progressive deterioration of renal function, respiratory failure, need for intensive care support, and administration of multiple antimicrobial agents, including liposomal amphotericin B, vancomycin, and rifampicin. After extensive investigation with computed tomography, fiberoptic bronchoscopy, biopsy, and microbiological cultures, a diagnosis of pulmonary coinfection by mucormycosis and Rhodococcus equi was established. Despite intensive therapeutic measures, the patient progressed to death following clinical deterioration. This case highlights the diagnostic and therapeutic challenges of coinfection with two rare opportunistic pathogens in a transplant recipient, reinforcing the importance of early recognition, prompt management, and aggressive intervention in such scenarios.

Downloads

Download data is not yet available.

References

ALVES, Y. et al. “Relato de caso: mucormicose em rim transplantado Case report: mucormycosis in renal allograft”. J Bras Nefrol, v. 24, n. 3, p. 153–159, 2002.

BRASIL. Ministério da Saúde. Boletim epidemiológico “Murcomicose” 2024. Brasília:/https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/m/mucormicose. Acesso em: 08 de fevereiro de 2025.

COHEN, N. D. et al. “Association of pneumonia with concentrations of virulent Rhodococcus equi in fecal swabs of foals before and after intrabronchial infection with virulent R. equi”. Journal of Veterinary Internal Medicine, Hoboken, v. 36, n. 3, p. 1139-1145, 2022. DOI: 10.1111/jvim.16409.

DANDU, H.; SHARMA, V.; SINGH, R.; GUPTA, A.; KHANDELWAL, P.; MEHROTRA, R.; & KUMAR, A. (2024). “Utility of Itraconazole in Combination with Liposomal Amphotericin B in Rhizopus oryzae Associated Mucormycosis–An Exploratory Study”. Mycopathologia, 189(4), 54.

DRAVID, A.; SAOJI, R.; BHALERAO, M.; GAIKWAD, P.; DOSHI, R.; & JOG, S. (2022). “Epidemiology, clinical presentation and management of COVID‐19 associated mucormycosis: A single centre experience from Pune.” Western India. Mycoses, 65(5), 526-540.

ESHRAGHI, B.; RAHIMI, M.; AMINI, A.; SHIRAZI, M. T.; NASIRI, M.; KARIMI, Z.; & SADEGHI, A. (2024). “Risk Factors of COVID-19 associated mucormycosis in Iranian patients: a multicenter study”. BMC Infectious Diseases, 24(1), 852.

FARIAS, L. A. B. G., DAMASCENO, L. S., BANDEIRA, S. P., BARRETO, F. K. DE A., LEITÃO, T. DO M. J. S., & CAVALCANTI, L. P. DE G. (2021). “COVID-19 associated Mucormycosis (CAM): Should Brazil be on alert?” Revista Da Sociedade Brasileira de Medicina Tropical, 54, e0410. https://doi.org/10.1590/0037-8682-0410 2021

GANDHI, A.; KUMAR, A.; GUPTA, N.; SHARMA, P.; YADAV, H.; & SHARMA, R. (2023). “Battling the emerging epidemic of rhino-orbital-cerebral mucormycosis (ROCM) in COVID-19 pandemic: an interventional study”. International Ophthalmology, 43(5), 1571–1580.

GONZÁLEZ-RONCERO FM, GENTIL MA, RODRIGUEZ-ALGARRA G, PEREIRA P, CISNEROS JM, CASTILLA JJ, ROCHA JL, MATEOS J. “Medical management of pneumonia caused by Rhodococcus equi in a renal transplant recipient. Am J Kidney Dis. 2002” Feb;39(2):E7. doi: 10.1053/ajkd.2002.30574. PMID: 11840398.

GURTLER, V. et al. Can whole genome analysis refine the taxonomy of the genus Rhodococcus? FEMS Microbiology Reviews, v.28, n.3, p.377-403, 2004.

HASE, A. et al. “Successful Management of Pulmonary Mucormycosis Presenting as Round Pneumonia by Lung Resection in a Kidney Transplant Recipient”. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, v. 34, n. Suppl 1, p. S226–S229, jan. 2023.

HUSSAIN, M. K.; KHAN, M. S.; AHMAD, I.; SHARIQ, A.; SINGH, M.; NAEEM, A.; & KHAN, R. A. (2023). “Mucormycosis: A hidden mystery of fungal infection, possible diagnosis, treatment and development of new therapeutic agents. European” Journal of Medicinal Chemistry, 246, 115010.

JAIN, V.; SHARMA, A.; KAPOOR, S.; GUPTA, P.; KUMAR, A.; & AGRAWAL, R. (2023). Hit or Miss: “The dilemma of specimen selection for microbiological diagnosis of rhino-orbital-cerebral-COVID-associated mucormycosis (ROCM-CAM). Infectious Disorders-Drug Targets” (Formerly Current Drug Targets-Infectious Disorders), 23(1), 62-69.

JEONG, W., KEIGHLEY, C., WOLFE, R., LEE, W. L., SLAVIN, M. A., KONG, D. C. M., & CHEN, S. C.-A. (2019). “The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports”. Clinical Microbiology and Infection, 25(1), 26–34. https://doi.org/10.1016/j.cmi.2018.07.011

KESHRI, A.; KUMAR, A.; KUMAR, S.; PANDEY, R.; & SINGH, P. (2023). “Is mucormycosis the end? A comprehensive management of orbit in COVID-associated rhino-orbital–cerebral mucormycosis: preserving the salvageable”. European Archives of Oto-Rhino-Laryngology, 280(2), 819-827.

KHARE, P.; CHAURASIA, Y.; & BHATNAGAR, S. (2022). “Exploring the globe salvaging treatment options in patients of COVID-19-associated mucormycosis with orbital involvement”. Indian Journal of Ophthalmology, 70(10), 3638-3642.

KIRKAN, Ş. et al. “Detection of Rhodococcus equi by PCR from foals and determination of antimicrobial susceptibility”. Turkish Journal of Veterinary and Animal Sciences, v. 45, n. 3, p. 396-403, 2021. DOI: 10.3906/vet-2011-109, 2025.

KULKARNI, R.; MISRA, U. K.; MESHRAM, C.; KOCHAR, D.; MODI, M.; VISHNU, VENUGOPALAN, Y.; GARG, R. K.; & SURYA, N. (2022). “Epidemic of mucormycosis in COVID-19 pandemic: a position paper”. Annals of Indian Academy of Neurology, 25(1), 7–10.

LIANG, G.-F. et al. “Pleural empyema with endobronchial mass due to Rhodococcus equi infection after renal transplantation: A case report and review of literature”. World Journal of Clinical Cases, v. 12, n. 1, p. 224–231, 2 jan. 2024.

LIANG, M. et al. “Epidemiology, pathogenesis, clinical characteristics, and treatment of mucormycosis: a review”. Annals of Medicine, v. 56, n. 1, 2 set. 2024.

MACKEN, E. et al. “Rhodococcus equi Sepsis in a Renal Transplant Recipient. Transplantation Direct, v. 1, n. 3, p. 1–6, abr. 2015.

MACKENZIE, C. “An update on Rhodococcus equi pneumonia in foals”. Uk-Vet Equine, v. 7, n. 1, p. 6-9, 2023.

MEDEIROS, P. R. et al. “Survey on sanitary practices and knowledge about infectious diseases among equine owners in the State of Rio Grande do Norte, Brazil. Brazilian” Journal of Veterinary Medicine, v. 45, p. 1-12, 2023.

MEGALE, R. S.; LINO, E. Z. B.; RIBEIRO, A. “Infecção por Rhodococcus equi em potra: relato de caso”. Pubvet, v. 17, n. 9, p. 1-6, 18 set. 2024.

PRESCOTT, J. “Rhodococcus equi: an Animal and Human Pathogen”. CLINICAL MICROBIOLOGY REVIEWS, v. 4, n. 1, p. 20–34, 1991.

RAKOWSKA, A. et al. “Investigation of the relationship between pulmonary lesions based on lung ultrasound and respiratory clinical signs in foals with suspected pulmonary rhodococcosis”. Scientific Reports, v. 13, n. 1, p. 19401, 2023. DOI: 10.1038/s41598-023-46833-2.

RIET-CORREA, F. et al. “Doenças de equinos e ruminantes”. 4. ed. São Paulo: Livraria Varela, 2022. v. 2, p. 306–314.

SEVERO, L. C. et al. Infecção pulmonar por “Rhodococcus equi”: relato dos dois primeiros casos brasileiros. Jornal de Pneumologia, v. 27, n. 3, p. 158–162, 1 maio 2001.

SONG, Y. et al. Mucormycosis in renal transplant recipients: review of 174 reported cases. BMC Infectious Diseases, v. 17, p. 283, 18 abr. 2017.

VAROTTI, G. et al. “Unusual Extrapulmonary Rhodococcus Equi Infection in a Kidney Transplant Patient. Experimental and clinical transplantation”. official journal of the Middle East Society for Organ Transplantation, v. 14, n. 6, p. 676–678, dez. 2016.

VERGIDIS, P. et al. RhodococcusInfection in Solid Organ and Hematopoietic Stem Cell Transplant Recipients1”. Emerging Infectious Diseases, v. 23, n. 3, p. 510–512, mar. 2017.

Published

2026-02-12

How to Cite

de Queiroz, C. A., Kisner, A. V., Pereira, H. M. D., Ribeiro, V. N., Foletto, K. A., & Batista, A. R. (2026). CASE REPORT: PULMONARY MUCORMYCOSIS AND RHODOCOCCOSIS IN A RENAL TRANSPLANT PATIENT. Revista De Geopolítica, 17(2), e1535. https://doi.org/10.56238/revgeov17n2-052