# Rhodococcus equi and Brucella pulmonary mass in immunocompetent: A case report and literature review

## TL;DR

A 53-year-old immunocompetent man with a history of goat farming had a rare co-infection of Rhodococcus equi and Brucella, requiring specific treatment for recovery.

## Contribution

This case report highlights the diagnostic and therapeutic challenges of a rare co-infection in an immunocompetent individual.

## Key findings

- The patient presented with atypical symptoms and radiological findings of a right hilar mass and vertebral destruction.
- Initial antibiotic treatment failed, but a tailored regimen with azithromycin, etimicin, minocycline, and moxifloxacin led to clinical improvement.
- The case emphasizes the need for precise microbiological testing in managing complex co-infections.

## Abstract

Rhodococcus equi, predominantly recognized as an opportunistic pathogen affecting immunocompromised hosts, and Brucella, a widespread zoonotic bacterium, infrequently co-infect immunocompetent adults, thereby posing a distinctive diagnostic challenge. Here, we describe a case involving a 53-year-old male with a history of goat farming, who presented with persistent chest tightness, cough, and notable weight loss, absent fever. Radiological and bronchoscopic assessments showed a right hilar mass, extensive vertebral destruction, and bronchial lesions, deviating from the typical symptoms associated with either pathogen. Laboratory analyses confirmed a co-infection involving R. equi and Brucella. Initial therapy with levofloxacin and vancomycin proved ineffective; however, a subsequent treatment regimen comprising azithromycin, etimicin, minocycline, and moxifloxacin resulted in substantial clinical improvement. This case accentuates the intricacies involved in diagnosing and managing atypical co-infections in immunocompetent individuals and underscores the importance of careful microbiological testing to inform effective therapeutic strategies.