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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Background: This case highlights an enterorenal fistula as a rare complication from ureteroscopic lithotripsy. Case Presentation: A 56-year-old woman with significant obesity, decompensated cirrhotic and ascitic liver disease, hypertension, type 2 diabetes mellitus, and nephrolithiasis treated with five prior ureteroscopic lithotripsies for a partial left staghorn stone presented to the emergency department (ED) with worsening left flank pain and sepsis. A CT scan of the abdomen and pelvis with contrast showed a large left perinephric hematoma. She underwent drain placement and during fluoroscopic imaging, there was a fistula from the left subcapsular hematoma/abscess to the proximal descending colon. The patient wished to proceed with a surgical course involving nephrectomy with hemicolectomy despite extensive counseling regarding her high mortality risk. However, because of worsening nutritional status as well as several other high-risk comorbidities, a shared decision was made with the patient to postpone the procedure. The patient was discharged to a skilled nursing facility for nutritional optimization and prehabilitation; however, she continued to decline with recurrent sepsis and cirrhosis-related complications and unfortunately passed away. Conclusion: A subscapular hematoma evolving into a perinephric abscess is a rare but known complication of ureteroscopic lithotripsy; however, this patient developed an enterorenal fistula that has yet to be reported after repeated ureteroscopy.
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PMID:Enterorenal Fistula as an Unusual Complication from Ureteroscopic Lithotripsy: A Case Report. 3117 84

We describe a rare case of methicillin-sensitive staphylococcus aureus (MSSA) septicemia with metastatic spread leading to pulmonary septic emboli, sub-capsular perinephric renal abscess, prostatic abscess, and intramuscular calf and gluteal abscess in a 48-year-old male with uncontrolled diabetes mellitus (Hemoglobin A1c of 15.2). The patient developed right lower extremity pain after a session of acupuncture followed by a three-week history of fevers, chills, abdominal pain, left flank pain, and urinary retention. Evaluation was negative for endocarditis, intracardiac shunt, intravenous drug usage, or immunodeficiency.
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PMID:Unusual Infectious Metastases Secondary to Acupuncture Induced MSSA Septicemia. 3242 27

We report a 71-year-old woman who presented with unilateral flank pain and sepsis. A computed tomographic (CT) scan demonstrated left-sided hydronephrosis. Subsequent percutaneous nephrotomy drainage showed pus-like material, confirming the diagnosis of pyonephrosis. The ureteral stricture was caused by previous radiation injury for cervical cancer in this ESRD patient who was on chronic dialysis for years. In our case, the grade IVB hydronephrosis is a result of an extremely atrophic kidney, pyonephrosis, and ureteral stricture. The CT section of pyonephrosis in an extremely atrophic kidney resembles a sagittal section of a Nautilus shell, as the shell corresponds to the diffusely thinned renal cortex.
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PMID:A Nautilus kidney. 3278 70

BACKGROUND There is growing evidence suggesting that Filshie clip migration is a rare but significant late complication following tubal sterilization. Although most women are asymptomatic, clip migration can result in serious morbidity such as abscess formation and be a source of sepsis years later. CASE REPORT A 51-year-old woman presented with 2-week history of worsening right flank pain with fever and chills, unresponsive to oral antibiotics. CT imaging showed a 4-cm anterior bladder wall mass with a tubal ligation clip within, initially suspicious for a tumor, with secondary infection. Cystoscopy was unremarkable and tumor markers were negative. A subsequent CT urography confirmed the finding of right adnexal abscess with ligation clip within, suggesting a diagnosis of pelvic inflammatory disease. Due to failure of conservative management, she underwent a diagnostic laparoscopy, which was then converted to an exploratory laparotomy due to dense omental adhesions. A Filshie clip was found within the bladder wall abscess and removed. An inadvertent bladder dome perforation was repaired. Pain and fever resolved after the operation and she was discharged home on post-op day 4 with an indwelling catheter. A micturating cystogram a month later showed no extravasation of contrast and the catheter was removed. CONCLUSIONS This case report highlights the importance of considering Filshie clip migration as a differential diagnosis vs. pelvic inflammatory disease in women without other risk factors and who had previously undergone tubal ligation. Women should be made aware of this potential, rare late complication and its serious morbidity, which may occur years later.
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PMID:An Unusual Case of a Filshie Clip Presenting as a Bladder Wall Abscess 12 Years After Sterilization. 3263 54

Acute pyelonephritis is a bacterial infection of the kidney and renal pelvis and should be suspected in patients with flank pain and laboratory evidence of urinary tract infection. Urine culture with antimicrobial susceptibility testing should be performed in all patients and used to direct therapy. Imaging, blood cultures, and measurement of serum inflammatory markers should not be performed in uncomplicated cases. Outpatient management is appropriate in patients who have uncomplicated disease and can tolerate oral therapy. Extended emergency department or observation unit stays are an appropriate option for patients who initially warrant intravenous therapy. Fluoroquinolones and trimethoprim/sulfamethoxazole are effective oral antibiotics in most cases, but increasing resistance makes empiric use problematic. When local resistance to a chosen oral antibiotic likely exceeds 10%, one dose of a long-acting broad-spectrum parenteral antibiotic should also be given while awaiting susceptibility data. Patients admitted to the hospital should receive parenteral antibiotic therapy, and those with sepsis or risk of infection with a multidrug-resistant organism should receive antibiotics with activity against extended-spectrum beta-lactamase-producing organisms. Most patients respond to appropriate management within 48 to 72 hours, and those who do not should be evaluated with imaging and repeat cultures while alternative diagnoses are considered. In cases of concurrent urinary tract obstruction, referral for urgent decompression should be pursued. Pregnant patients with pyelonephritis are at significantly elevated risk of severe complications and should be admitted and treated initially with parenteral therapy.
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PMID:Acute Pyelonephritis in Adults: Rapid Evidence Review. 3273 33

Background: Fungal masses (fungal ball or bezoars) rarely present as renal calculus. More so, Trichosporon species are even more uncommon among the noncandidial fungal infections affecting urinary tract. We report two such interesting cases that are not yet reported in the current literature. Case Reports: Our first case is a 48-year-old gentleman with diabetes presented with fever and flank pain. He was found to have bilateral obstructing radiolucent renal calculi with azotemia. Initially managed with bilateral Double-J stenting after one session of hemodialysis, and subsequently bilateral percutaneous nephrolithotomy (PCNL) was accomplished. Our second patient is a 37-year-old lady presented with bilateral flank pain with no comorbidity or sepsis. On evaluation, she was found to have bilateral radiolucent staghorn calculi and for which bilateral PCNL was performed. In view of high suspicion of fungal infection, extracted soft floppy materials were sent for fungal culture and were treated with antifungal agents after Trichosporon species was detected. Conclusion: Although renal fungal infections are rare, a strong suspicion and timely definitive management of such entities in patients with radiolucent renal calculus can prevent devastating invasive disease.
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PMID:Fungal Balls Mimicking Renal Calculi: A Zebra Among Horses. 3277 55


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