Severe Rhodococcus equi pneumonia following hepatic arterial infusion chemotherapy combined with sintilimab and lenvatinib in hepatocellular carcinoma: a case report

Rhodococcus equi is a Gram-positive aerobic bacterium primarily associated with pulmonary infections in animals. Although rare in humans, such infections typically affect immunocompromised individuals, often presenting with severe pulmonary manifestations such as lung abscesses or cavitary pneumonia. This report describes a patient with advanced hepatocellular carcinoma (HCC) who developed cavitary pneumonia after receiving hepatic arterial infusion chemotherapy combined with sintilimab and lenvatinib. Diagnosis of Rhodococcus equi infection was confirmed via bronchoalveolar lavage fluid (BALF) analysis. The infection was successfully managed with an adjusted antibiotic regimen of imipenem/cilastatin, levofloxacin, and amikacin.