Infect Chemother.  2015 Sep;47(3):183-189. 10.3947/ic.2015.47.3.183.

A Case of Recurrent Meningitis Caused by Rhodococcus species Successfully Treated with Antibiotic Treatment and Intrathecal Injection of Vancomycin through an Ommaya Reservoir

• Lee K
• Rho M
• Yu M
• Kwak J
• Hong S
• Kim J
• Kim Y
• Pai H

• KMID: 2068984
• DOI: http://doi.org/10.3947/ic.2015.47.3.183

Abstract

Human infection by Rhodococcus species is rare and mostly limited to immunocompromised hosts such as patients infected with the human immunodeficiency virus (HIV) or organ transplant recipients. The most common strain is R. equi, and the most common clinical presentation is pulmonary infection, reported in 80% of Rhodococcus spp. infections. The central nervous system is an uncommon infection site. We report a case of a patient with pneumonia, brain abscess, and recurrent meningitis caused by Rhodococcus spp. He initially presented with pneumonia with necrosis, which progressed to brain abscess and recurrent meningitis. Rhodococcus spp. was identified from the cerobrospinal fluid (CSF) collected during his fourth hospital admission. Despite prolonged treatment with appropriate antibiotics, meningitis recurred three times. Finally, in order to administer antibiotics directly into the CSF and bypass the blood-brain barrier, an Ommaya reservoir was inserted for administration of 90 days of intrathecal vancomycin and amikacin in conjunction with intravenous and oral antibiotics; the patient was finally cured with this treatment regimen.

Keyword

Rhodococcus species; Recurrent meningitis; Ommaya reservoir; Vancomycin

MeSH Terms

Amikacin
Anti-Bacterial Agents
Blood-Brain Barrier
Brain Abscess
Central Nervous System
HIV
Humans
Immunocompromised Host
Injections, Spinal*
Meningitis*
Necrosis
Pneumonia
Rhodococcus*
Transplants
Vancomycin*
Amikacin
Anti-Bacterial Agents
Vancomycin

Figure

• 

  Figure 1 Chest computed tomography scan with enhancement. (A) At first admission, lobulating contour mass-like consolidations with necrosis are visible in the left lower lobe and right lower lobe basal territory (☆). (B) Pneumonic infiltration of the left lower lobe superior segment improved, but the extent of the pneumonic consolidations increased with the newly developed internal necrotic component at the right lower lobe (arrow). (C) Pneumonic consolidations at the right lower lobe and left lower lobe superior segment showed improvement. *(Number) is the time elapsed from the first admission date (days).

• 

  Figure 2 Brain magnetic resonance images (MRI). (A) Multiple aggregated enhancing lesions with surrounding edema in the left cerebellum, midbrain, pons, and supratentorial parenchyma (arrowheads). (B) Decreased number of enhanced lesions compared with previous MRI (). (C) Improvement of the previous lesions except for mild worsening of pontine lesions (☆). *(Number) is the time elapsed from the first admission date (days).

• 

  Figure 3 Clinical course of patient with necrotizing pneumonia, brain abscess, and relapsing meningitis due to Rhodococcus spp. Bold line: white blood cell counts in cerebrospinal fluid (CSF). Dotted line: body temperatures (℃). aDay: time elapsed from the first admission date. bCSF study: white blood cell (WBC) (/mm3), neutrophil (%), lymphocyte (%), protein (mg/dL), glucose (mg/dL). cDuration (days) and antibiotics administered: VAN, vancomycin; TEC, teicoplanin; LZD, linezolid; CRO, ceftriaxone; MEM, meropenem; IPM-C, imipenem-cilastatin; DOX, doxycycline; AMK, amikacin; RIF, rifampin; MXF, moxifloxacin; LVX, levofloxacin; AZM, azithromycin; CLI, clindamycin; TMP/SMX, trimethoprim-sulfamethoxazole, IT, intrathecal.

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