Diseminovana Rhodococcus equi infekcija kod bolesnice sa  Hočkinovim limfomom

Dragan Mikić; Zoran Djordjević; Leposava Sekulović; Miroslav Kojić; Branka Tomanović

doi:10.2298/3139

Dragan Mikić Clinic for Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Zoran Djordjević Institute for Radiology, Military Medical Academy, Belgrade, Serbia
Leposava Sekulović Institute for Radiology, Military Medical Academy, Belgrade, Serbia
Miroslav Kojić Clinic for Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia
Branka Tomanović Institute for Microbiology, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/3139

Ključne reči: rhodococcus equi||, ||rhodococcus equi, hodgkin disease||, ||hodžkinova bolest, immunologic deficiency syndromes||, ||imunitet, sindromi nedostatka, infection||, ||infekcija, sepsis||, ||sepsa, anti-bacterial agents||, ||antibiotici, drug therapy, combination||, ||lečenje, kombinovano,

Sažetak

Uvod. Rhodococcus (R) equi je oportuni patogen koji retko uzrokuje oboljenje u humanoj populaciji, uglavnom kod imunokompromitovanih domaćina. Oboljenje se obično ispoljava kao subakutna pneumonija koja je često kavitarna i neretko praćena bakterijemijom. Prikaz bolesnika. Prikazujemo veoma redak slučaj bolesnice stare 43 godina sa Hočkinovim limfomom, kod koje je došlo do razvoja R. equi pneumonije u toku primene hemoterapije. Kasnije, kod bolesnice je došlo do razvoja bakterijemije i sepse uz diseminaciju R. equi infekcije u brojna ekstrapulmonalna tkiva. Na prijemu bolesnica je bila febrilna, tahipnoična, tahikardična, hipotenzivna, sa otokom lica, splenomegalijom, pozitivnim meningealnim znacima, levostranom hemiparezom i paraparezom. U laboratorijskim nalazima sedimentacija eritrocita (SE) bila je > 140 mm/h, C-reaktivni protein (CRP) 143,0 mg/L, eritrociti 2,14 × 10⁹/L, leukociti 2,8 × 10¹²/L, lektat dehidrogenaza (LDH) 706 U/L, serumski albumin 26 g/L, natrijum 127 mmol/L i kalijum 2,7 mmol/L. Hemokulturom i kulturom sputuma i empijema izolovan je R. equi. Radiološke metode registrovale su veliku kavitarnu pneumoniju i apsces pluća, empijem pleure, perikarditis, medijastinalnu i abdominalnu limfadenopatiju, apsces mozga i psoasa, osteomijelitis i spondilodiscitis. Bolesnica se potpuno oporavila nakon 12 meseci terapije kombinacijama parenteralnih i peroralnih antibiotika, uz primenu drenaže apscesnih kolekcija i empijema. Osam godina po završenoj terapiji kod bolesnice nije zabeležen recidiv R. equi infekcije niti limfoma. Zaključak. S obzirom na to da je eradikacija R. equi veoma teška, od velike je važnosti što ranije postaviti dijagnozu i otpočeti adekvatnu antibiotsku terapiju.

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