Rhodococcus pneumonia in human-immunodeficiency-virus infection

A 42-year old patient presented with hemoptysis and fever and a cavitating middle lobe infiltrate on thoracic computed tomography. The tuberculin skin test and a Mycobacterium tuberculosis-specific enzyme linked immunospot (T-Spot.TB) were non-reactive. Corynebacterium spp. was cultured form bronchoalveolar lavage (BAL) fluid, but the organism was not further identified. On treatment with a oral fluorochinolone the infiltrates did not resolve and the patient was hospitalised for further diagnosis and treatment. On admission lymphocytopenia of 0,17/nl was noted. The number of circulating CD4+ T-cells was 16.4/µl…