Delayed but Salvaged: Rhodococcus Lung Abscess in a Patient With Undiagnosed HIV/AIDS

BACKGROUND Rhodococcus species is an opportunistic pathogen in immunocompromised conditions, including HIV/AIDS. It primarily causes necrotizing pneumonia and can clinically mimic pulmonary tuberculosis (TB), which is relevant in settings with a high TB burden, such as Pakistan. This case report presents a late diagnosis of HIV/AIDS associated with Rhodococcus lung abscess, which was initially treated as pulmonary TB and lung abscess. CASE REPORT A man in his 30s presented with a 1-month history of fever, weight loss, cough, night sweats, and chest pain. He denied exposure to soil or horses. He received empiric treatment for suspected pulmonary TB and lung abscess, with poor clinical response. A CT-guided lung biopsy confirmed the microbiological diagnosis of Rhodococcus lung abscess approximately 3 to 4 months after the symptom onset. HIV screening was unfortunately delayed due to the rarity and poor awareness of Rhodococcus as an opportunistic pathogen in the HIV population. AIDS was diagnosed 5 months after symptom onset. Antiretroviral therapy and culture-directed treatment for Rhodococcus lung abscess was initiated, with good clinical outcome. CONCLUSIONS Pakistan ranks fifth globally among high-burden TB countries and yet lacks healthcare resources. Prompt recognition of Rhodococcus infection should trigger HIV screening and early multidisciplinary management, to optimize outcomes in resource-limited, TB-endemic settings.