Renal embolism as a primary manifestation of Streptococcus dysgalactiae subspecies equisimilis endocarditis in a patient with chronic aortic dissection.

We report a case of renal embolism as an initial manifestation of Streptococcus dysgalactiae subspecies equisimilis (SDSE) endocarditis in a patient with chronic aortic dissection. A 37-year-old man who underwent total aortic arch replacement owing to aortic dissection, presented with a 3-h history of fever, chills, and acute right-sided flank pain. The endocarditis affected the native aortic valve and was complicated by a renal embolism. Blood culture results were positive for SDSE. Intravenous penicillin resulted in satisfactory clinical and echocardiographic recovery.

Obstructed kidney and sepsis secondary to urethral catheter misplacement into the distal ureter.

An 86-year-old woman underwent routine catheter replacement in the community. The new catheter failed to drain urine. Attempts to remove the catheter failed, both by the community nurse as well as by the urology team in the hospital. A CT scan confirmed that the catheter balloon was inflated in the distal right ureter. The patient was started on antibiotics and listed for cystoscopy under general anaesthetic. The catheter was visualised entering the right ureter and the balloon punctured using a wire under image intensifier guidance. Once removed, a new catheter was inserted. Very dilated ureteric orifices were noted. Post operatively the patient required HDU support for 48 h due to sepsis and on recovery was discharged home. The key learning point in this case is to always consider catheter misplacement in the ureter if it is not draining well and the patient presents with pain.

Tuberculosis of the renal artery: a rare cause of renovascular arterial hypertension.

Tuberculosis is an endemic disease in Morocco. Main blood vessels are rarely affected; the few mentioned cases are aneurysmal. We report a 17-year-old patient presenting with renovascular arterial hypertension, revealed thanks to the discovery of an occlusion of the right renal artery in Duplex scan. During the intervention, the observation of pararenal and mesenteric tuberculous polyadenopathy let us suggest the same kind of lesion at the level of the occluded renal artery. Once antituberculosis treatment had been carried out, the right renal artery was revascularized with a right iliorenal bypass using reversed internal saphenous vein. The postoperative course was uneventful, with an 18-month follow-up. Arterial pressure was normal without antihypertensive treatment, and the bypass was patent. As far as we know, this is the first case of renovascular arterial hypertension resulting from tuberculosis treated with an iliorenal bypass.

Bacterial endocarditis presenting with unilateral renal artery occlusion treated with the Rinspirator Thrombus Removal System rinsing and thrombectomy device and suction thrombectomy.

We report a 36-year-old man who presented with unilateral flank pain caused by renal artery occlusion with ischemia and infarction from septic emboli secondary to bacterial endocarditis. We treated the occlusion with a novel rinsing and aspiration device, the Rinspirator Thrombus Removal System (ev3, Plymouth, Minn) and suction thrombectomy, which resulted in significant revascularization of the kidney and relief of symptoms. Postprocedural imaging demonstrated marked improvement in renal vascularization, with only small areas of infarction. This technique may be useful in patients where the embolic material is chronic or thrombolytic agents are contraindicated.

Isolated renal mucormycosis: an unusual cause of acute renal infarction in a boy with aplastic anaemia.

Mucormycosis is an opportunistic fungal infection occurring most often in immunocompromised patients. The most common clinical presentation of infection with the fungus is rhinocerebral, followed by primary pulmonary, disseminated, gastrointestinal and cutaneous manifestations. Renal involvement in disseminated mucormycosis is well described, however, there are only few case reports describing the isolated renal mucormycosis in literature. We present an unusual case of renal mucormycosis in a patient of aplastic anaemia who presented with right flank pain and, on imaging, was found to have renal infarction and thrombosis of renal vessels. Histopathology revealed fungal hyphae infiltrating the entire kidney, renal vessels and perinephric space.