Infecção disseminada por Rhodococcus em doente imunossuprimida. Disseminated Rhodococcus infection in an immunocompromised patient

Known as an animal disease agent, Rhodococcus has been increasingly associated with infection in immunosuppressed patients. A 55 year-old female patient, diagnosed with dermatomyositis one year before and under corticosteroids, presented with respiratory symptoms and evidence of bilateral pulmonary nodules that responded well to a short course of antibiotics. Three weeks later she presented with inflammatory signs on the abdominal wall and a large intrabdominal abscess was diagnosed. The abscess was surgically drained and antibiotics were started. The pus culture grew gram positive bacilli, disregarded as contamination. Pus culture was repeated, revealing Rhodococcus spp, and antimicrobial therapy was altered to ciprofloxacin and cotrimoxazole. After hospital discharge the patient was diagnosed with gastric adenocarcinoma and underwent surgery, chemotherapy and radiotherapy, maintaining the antibiotic suppressive regimen. A close relationship between the treating physician and the microbiologist is beneficial in diagnosing infections by atypical pathogens in immunosuppressed patients.