Rhodococcus Hoagii Masquerading as Tuberculosis: A Case Report

Abstract

A young 35-year-old male presented with a cough, chest pain, breathlessness and bilateral lower limb swelling. He had been an alcoholic for over 21 years and had a history of Antitubercular Therapy (ATT) for six months due to tuberculous pleural effusion, which occurred a year ago. Bronchoscopy and Endobronchial Ultrasound-Transbronchial Needle Aspiration (EBUS-TBNA) revealed granulomatous lesions and acid-fast bacilli, although they were not morphologically similar to mycobacteria or Nocardia. GeneXpert-Mycobacterium Tuberculosis (MTB) and bacterial cultures were inconclusive. He was subsequently started on modified ATT. However, due to clinical worsening, a Computed Tomography (CT)-guided Fine Needle Aspiration (FNA) was performed, which revealed pus; cultures detected Rhodococcus hoagii. The patient was then commenced on rifampicin and ciprofloxacin. Unfortunately, his compliance with the treatment was poor and he ultimately succumbed to the infection. The present case demonstrates that Rhodococcus hoagii infection, a rare cause of fatal pneumonia, can mislead physicians into misdiagnosing tuberculosis.

Keywords

• acid fast bacilli
• consolidation
• endobronchial ultrasound
• fine needle aspiration
• granulomatous lesion
• tree-in bud nodules