Rare case of Rhodococcus hoagii bacteremia in an HIV late‑presenter with NTM pulmonary disease: A case report and review of the literature

The present study describes the case of a 33‑year‑old male patient, who was diagnosed with concurrent infections of Rhodococcus hoagii (R. hoagii), Mycobacterium intracellulare (M. intracellulare), human immunodeficiency virus (HIV) and syphilis. This patient, a homeless farm laborer with no prior medical treatments, exhibited symptoms including persistent fever and cough, and was admitted to hospital. Treatment was initiated with a combination of anti‑retroviral therapy with emtricitabine/tenofovir alafenamide/dolutegravir, and antibiotics (azithromycin, rifampicin, amikacin and ethambutol) targeted at both R. hoagii and M. intracellulare, alongside adjustments for drug‑drug interactions due to rifampicin administration. Despite initial improvements and discharge after 21 days with scheduled outpatient follow‑ups, the patient did not return for further treatment monitoring. The case presented herein underscores the challenges in managing complex infections in severely immunocompromised patients and highlights the need for integrated treatment approaches, careful drug management, and robust follow‑up systems to ensure adherence and prevent relapse. In addition, the present case report contributes to the limited literature avail‑ able on R. hoagii infections in HIV‑infected individuals and highlights the need for early intervention and comprehensive management in similar clinical scenarios