Renal vein thrombosis complicating severe acute pyelonephritis with renal abscesses and associated bacteraemia caused by extended-spectrum beta-lactamase producing Escherichia coli

  • Stelios F. Assimakopoulos
  • Pantelis Kraniotis
  • Charalambos Gogos
  • Markos Marangos
Case Report

Abstract

Acute pyelonephritis might be complicated by the formation of renal and perirenal abscesses and very rarely by renal vein thrombosis, which is a life-threatening condition. The main causative agents of acute pyelonephritis are enterobacteriaceae with the incidence of extended-spectrum beta-lactamase (ESBL)-producing strains increasing worldwide. We present the case of a 71-year-old Greek man with history of diabetes mellitus and recent hospitalization, who suffered from severe pyelonephritis with renal abscesses formation and associated bacteraemia caused by ESBL-producing Escherichia coli, complicated by extensive thrombosis of the ipsilateral renal vein and its branches, protruding also in the inferior venal cava. Our patient was effectively treated with anticoagulants and targeted antibiotic therapy, respectively, consisted of low molecular weight heparin transitioned to oral acenocoumarol for 3 months and 2-week course of intravenous meropenem followed by oral fosfomycin for additional 3 weeks as quidded by clinical and computed tomographic follow-up. In conclusion, in complicated urinary infections, caused by ESBL-producing enterobacteriaceae, oral fosfomycin might represent an effective option for step-down therapy of carbapenems, allowing the shortness of the duration of patient’s hospitalization and carbapenem use.

Keywords

Urinary tract infections Renal abscess Renal vein thrombosis Extended-spectrum beta-lactamase ESBL Fosfomycin 

Notes

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Human rights

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Stelios F. Assimakopoulos
    • 1
  • Pantelis Kraniotis
    • 2
  • Charalambos Gogos
    • 1
  • Markos Marangos
    • 1
  1. 1.Division of Infectious Diseases, Department of Internal MedicineUniversity General Hospital of PatrasPatrasGreece
  2. 2.Department of RadiologyUniversity General Hospital of PatrasPatrasGreece

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