[Encrusted Pyelitis during a case of Thrombotic Thrombocytopenic Purpura].

Encrusted pyelitis is a chronic urinary tract infection associated with mucosal encrustation induced by urea splitting bacteria. More than 40 bacteria have been implicated but the most frequent is Corynebacterium group D2. Predisposing factors are debilitating chronic diseases and preexisting urological procedures. Immunosoppression is an important cofactor. For these reasons the disease is almost always nosocomially acquired and renal transplant recipients are at particular risk. The symptoms are not specific and long lasting: dysuria, flank pain and gross haematuria are the most frequent; fever is present in two-thirds. The demonstration of urine splitting bacteria in constantly alkaline urines and radiological evidence of extensive calcification of pelvicalyceal system, ureter and bladder at US or CT scan in a clinical context of predisposing factors are the mainstay of diagnosis. Treatment is based on adapted antibiotic therapy, acidification of urine and excision of plaques of calcified encrustation. The prognosis relies on timing of diagnosis; delay can be detrimental and result in patient's death and graft loss. We describe a unique case of 69-year-old man with two contemporary diseases: autoimmune thrombotic thrombocytopenic purpura and encrusted pyelitis with a fatal evolution.

Pielitis enfisematosa: presentación de un caso / Emphysematous pyelitis: A case presentation

La pielitis enfisematosa se caracteriza por la presencia de gas en el sistema colector renal. Por considerarse una infección rara, el presente trabajo tiene como objetivo describir las características clínicas presentes en una enferma con dicha entidad. Se trata de una paciente femenina, de 52 años de edad, con antecedentes personales de diabetes mellitus tipo 2, de 12 años de evolución que recibe Insulina NPH. Varias hospitalizaciones anteriores por pielonefritis. Ingresa por fiebre de 38 ºC y 39 ºC de cinco días de duración, dolor moderado en la fosa lumbar derecha, irradiado a la región suprapúbica, disuria, vómitos acuosos abundantes y toma del estado general. En la ecografía renal y la tomografía axial computadorizada (TAC) se comprobó la presencia de gas en el sistema colector del riñón derecho. Se aisló Escherichia Coli en el cultivo de la orina. El tratamiento fue médico, a base de Cefotaxime y Amikacina. La evolución fue satisfactoria, desde el punto de vista clínico, de las imágenes y microbiológico(AU)

The emphysematous pyelitis is characterized by the presence of gas in the collector renal system. Taking into consideration that this is a weird disease, the main objective of this research is to describe the clinical characteristics of a female patient with this entity. This 52 year -old –patient presented personal antecedents of diabetes mellitus type II with 12 years of evolution who received NPH insuline and was previously hopitalized with pyelonephritis. She was hospitalized with five days long fever, moderated pain in the lumbar right area, irradiated in the suprapubic region, dissuria, several acuous vomiting and taking of the general stage. In the renal echography and computerized axial tomography it was evidenced the presence of gas in the colecting system of the right kidney. The escherichia coli was isolated in the urine culture. There was applied a medical treatment with Cefotaxime and Amikacine. The evolution was satisfactory from the clinic, image and microbiological point of view(EU)

[Encrusted pyelitis: early diagnosis facilitates conservative management]. / Pyélite incrustante: un diagnostic précoce facilite la prise en charge conservatrice.

Diagnosis of encrusted pyelitis in predisposed patients is difficult. The bacteriology laboratory must be specifically asked to perform the appropriate tests. Computed tomography without injection is very important for diagnosis and follow-up. Conservative treatment is essential insofar as possible. Long-term follow-up is also necessary.

Successful treatment of Corynebacterium urealyticum encrusted cystitis: a case report and literature review.

Encrusted cystitis is a very rare chronic inflammatory disease of the bladder characterized by precipitation and incrustation of phosphate and ammonium-magnesium salts on the vescical mucosa, caused by urinary infection due to urolithic microorganisms. Corynebacterium urealyticum or Corynebacterium group D2, a multiple antibiotic-resistant urea-splitting bacterium, is the most frequently incriminated aetiology. We report a case of a 57-year-old man affected by systemic erythematosus lupus with a long history of dysuria and suprapubic pain who underwent percutaneous nephrostomy drainage with urethral stenting for lupoid obstructive uropathy. Before the diagnosis of encrusted cystitis by Corynebacterium urealyticum was established, the patient underwent five cystoscopies to remove the plaques and multiple unsuccessful antibiotic treatment courses. Eventually the infection was definitively cured after a two-week course with intramuscular teicoplanin.

Encrusted cystitis and pyelitis in children: an unusual condition with potentially severe consequences.

OBJECTIVES: To report our experience with the management of encrusted cystitis and pyelitis (EC and EP) in the pediatric population. EC and EP are well-known entities in adults but are rarely identified in children. They consist of mucosal encrustations and are due to specific microorganisms. METHODS: Between 1996 and 2001, 4 children with a mean age of 9 years (range 4 to 13) were treated for EC (n = 2), EP (n = 1), and EC and EP (n = 1). The latter was a kidney transplant recipient. We retrospectively evaluated the clinical characteristics of the patients and the results of conservative management. RESULTS: The delay between the beginning of the symptoms and the diagnosis was longer than 1 month in all cases. The diagnosis of EC was not evoked and was made during cystoscopy in all cases. EP was diagnosed during pyelotomy in 1 patient because it was evoked and confirmed by computed tomography scan in the kidney transplant recipient. Corynebacterium urealyticum was identified in the urine of all patients. EC was treated by antibiotics and endoscopic debulking, and EP was treated by antibiotics and local acidification. The duration of antibiotic therapy was between 1 and 6 months. The tolerance to local acidification of the kidneys was poor. Cure was achieved in 3 cases, but the treatment of EP failed in the kidney transplant recipient and graft removal was decided after 6 months of failed management because intractable febrile urinary tract infections became life threatening for the patient. CONCLUSIONS: EC and EP are uncommon in children; however, these diseases must be considered. They must be diagnosed rapidly and require, if possible, conservative management. Nevertheless, kidney loss can occur in transplant recipients with EP.

Successful treatment of primary bilateral renal mucormycosis with bilateral nephrectomy.

Bilateral invasive renal mucormycosis has previously been associated with a 100% mortality rate. We report a case of bilateral invasive renal mucormycosis in a patient treated with amphotericin B and bilateral nephrectomy who survived and is currently disease-free.

[Corynebacterium urealyticum in renal trasplantation. CT and sonography imaging characteristics of encrusted cistitis and pielitis]. / Corynebacterium urealyticum en pacientes con trasplante renal. Imágenes características de la TC y ultrasonografía de la cistitis y pielitis incrustante.

PURPOSE: Its described three cases of Corynebacterium urealyticum (CU) infection in patients with renal transplantation and one of its most serious consequences: encrusted pyelitis and cystitis. It is explained the principal keys for its diagnosis, based in the appearance of alkaline pH in in urine analysis (alkaline urine), positives urinary cultures for CU, and the CT and US studies revealed the characteristic images of calcifications in the wall of renal pelvis and bladder. PATIENTS: Three male patients with renal transplantation and CU infection that caused encrusted pyelitis in two of the cases and encrusted cystitis in one case. RESULTS: Calcifications of the urinary tract were noticed in CT in all the patients. In two cases bladder stones were linear, and in the third case they were fundamentally coarse and placed in pelvis. The diagnosis suspicion showed by the images was confirmed by the use of prolonged urine cultures, necessary for detecting CU. All the patients were treated with vancomycin, with success in two of the cases and, finally needing surgery, and after loss of the graft, in the other case. CONCLUSION: Encrusted pyelitis and cystitis are cronic and severe infections of the urinary tract. Calcic struvite incrustations in the urothelium are characteristics of this infection. CT is a choice technique for the diagnosis and followup of the calcifications after treatment.

Emphysematous pyelitis presenting as an acute abdomen in an end-stage renal disease patient treated with peritoneal dialysis.

Emphysematous pyelitis is air in the renal collecting system in patients with urinary tract infections. This entity is uncommon and seen primarily in patients with diabetes mellitus. We report a case of a patient with end-stage renal disease treated with peritoneal dialysis who developed emphysematous pyelitis who presented with signs and symptoms that were more consistent with appendicitis. The spectrum of infections causing air in the urinary tract and the method by which end-stage renal disease patients are treated are discussed. Patients receiving dextrose peritoneal dialysis are at risk for emphysematous pyelonephritis, pyelitis, and cystitis.

La pielitis incrustante: hallazgos en ecografía y TC / Encrusted pyelitis: ultrasound and computed tomography findings

La pielitis incrustante (PI) es una enfermedad infecciosa producida por Corynebacterium urealyticum, cuya prevalencia es muy elevada en pacientes con trasplante renal que ha sufrido frecuentes manipulaciones urológicas y tratamientos antibióticos prolongados. Esta enfermedad es de graves consecuencias para el paciente si no se realiza un diagnóstico y tratamiento antibiótico temprano. La ecografía y la TC muestran imágenes típicas de calcificación en el sistema colector, pudiendo ser la radiografía simple de abdomen normal. Describimos un caso de PI en un paciente transplantado renal (AU)

[Cystic pyeloureteritis. A review of the literature in the period of 1946-1994 and a report of a new case]. / Pieloureteritis quística. Revisión de la literatura, periodo 1946-1994 y presentación de un nuevo caso.

Presentation of a new case of unilateral cystic pyeloureteritis in a 46-year old female patient. The condition presented as a right renoureteral colic. A revision is made of the 69 national cases published on such an uncommon condition, of obscure etiologic, pathogenic and therapeutical features. The accent is placed on its most significant aspects, such as: difficulties of differential diagnosis with other repletion defect imagen in the excretory tract and their frequent association to other diseases.

Encrusted pyelitis and cystitis by Corynebacterium urealyticum (CDC group D2): a new and threatening complication following renal transplant.

We evaluated the pathogenic role of Corynebacterium urealyticum in the development of encrusted pyelitis (EP) and encrusted cystitis (EC), and their clinical consequences in renal transplant recipients. During a 4-year period, we studied seven renal transplant recipients with EP and two with EC. The records of 320 other renal transplant patients studied during the same period were used as a control group. C urealyticum (> or = 10(5) CFU/ml) was isolated from 4 patients with EP (urine 3, blood 1) and from 1 patient with EC (urine). Alkaline urines with struvite crystals, microscopic hematuria, and sterile conventional urine cultures were present in all our cases. All the patients with EP developed obstructive uropathy with deterioration of the renal function and pyelonephritis (4 patients) or renal abscesses (3 patients). Chronic urinary discomfort and macroscopic hematuria were present in the 2 patients with EC. Long-term vesical and ureteral catheterization were considered the most important risk factors for the development of EC and EP, respectively. Vancomycin was successfully used in 5 cases, but all the patients required a derivative procedure or a surgical resection of the incrustations to improve. We conclude that EP and EC should be investigated in renal transplant patients who develop pyelonephritis, obstructive uropathy, or chronic urinary symptoms. EP and EC could lead to the loss of their grafts. C urealyticum appears to have a pathogenic role in these entities.

Open randomized controlled parallel study of ofloxacin versus trimethoprim-sulfamethoxazole treatment of lower respiratory tract and urinary infections.

A total of 60 patients with lower respiratory tract or urinary tract infections were enrolled in an open, randomized, controlled, parallel study comparing 300 mg ofloxacin (OFX) b.i.d. with trimethoprim + sulfamethoxazole (TMP 800 mg + SMX 160 mg), 1 tablet, b.i.d. The signs and symptoms of low respiratory tract infection were cured in 12 patients (80%) of the OFX group and improved in 2 other patients (13%); at the end of therapy, the 2 germs that persisted were Streptococcus pneumoniae and Branhamella catarrhalis. Clinical cure was achieved in 13 patients (86%) in the TMP-SMX group, while 2 patients were considered as failures (14%); after therapy, the 3 organisms that persisted were 2 S. pneumoniae and 1 Pseudomonas aeruginosa. As far as urinary tract infections are concerned clinical cure and complete eradication of bacteria were achieved in 14 patients in the OFX group (93%); the germ that persisted was Escherichia coli (100,000 CFU), but the patient was asymptomatic. In patients of the TMP-SMX group the urinary infections were cured in 11 subjects (73%); the germs that persisted were 2 E. coli and 1 Proteus mirabilis. Adverse effects were reported for 3 patients (10%) in the OFX group and 4 patients (13%) in the TMP-SMX group. The measurement of serum and intracellular (polymorphonuclear cells and lymphocytes) levels of OFX and TMP-SMX and the assessment of the host's immunocompetence ruled out the possibility of any immunotoxicological side effect.