Hemodialysis catheter related rhodococcus bacteremia in immunocompetent host

Rhodococcus equi (R. equi) is an uncommon cause of infection in immunocompetent individuals. We describe a case of R. equi bacteremia associated with hemodialysis (HD) catheter in an immunocompetent patient. A 38-year-old female with end-stage renal disease (ESRD) of uncertain etiology,on HD for the past 15 months who was previously healthy otherwise,was admitted with the complaints of intermittent fever,mild nausea and occasional vomiting for two weeks. Last HD was performed four days earlier through a tunneled right internal jugular permacath. Clinically the patient was afebrile and in no acute distress. She was hemodynamically stable with no peripheral stigmata of an endovascular infection. Physical examination was essentially normal. Initially,the patient was treated with intravenous vancomycin with each HD,retaining the catheter. However,due to persistently positive blood cultures,HD catheter had to be removed. The patient became afebrile and nausea and vomiting resolved. She improved clinically,and repeated surveillance blood cultures done after the removal of catheter were reported negative. Subsequently,a new HD catheter was inserted for her. Although R. equi is an uncommon cause of infection in immunocompetent individuals,it does occur with considerable mortality and morbidity,and a high index of clinical suspicion is required to recognize this infection in immunocompetent individuals.