A man in his 40s on long-term immunosuppression with bilateral lung transplantation due to cystic fibrosis presented to the hospital with dysuria and flank pain, initially attributed to pyelonephritis. Repeated computed tomography revealed progressive bilateral hydronephrosis unresponsive to ureteric stenting, an extensive bladder wall lesion with calcification, and retroperitoneal lymphadenopathy. A cystoscopic biopsy reviewed at a tertiary centre confirmed high-grade urothelial carcinoma with extensive glandular differentiation, positive for the SV40 antigen, consistent with BK polyomavirus-associated carcinoma (G3 T1 N3 M1a). Persistent hydronephrosis despite appropriately situated stents was the pivotal imaging finding, prompting reassessment for extrinsic malignant obstruction and bilateral nephrostomy insertion. This case highlights the diagnostic challenge of distinguishing malignancy from infection in immunosuppressed individuals through serial imaging.

Campylobacter infections are very common overall. They typically affect the gastrointestinal tract and are usually caused by consumption of contaminated meat or water. Older people, men, and people with weakened immune systems are significantly more likely to be affected. Endocarditis caused by Campylobacter fetus, especially of the tricuspid valve, is rarely reported and not easy to diagnose.

In patients with familial adenomatous polyposis, intra-abdominal desmoid tumors should be recognized as a rare but important cause of ureteral obstruction and obstructive pyelonephritis. Prompt cross-sectional imaging, early recognition, and multidisciplinary management are essential for preserving renal function, treating infection, and preventing irreversible urinary tract complications.

Bullous pemphigoid (BP) is the most common autoimmune blistering disease in older adults and is increasingly associated with dipeptidyl peptidase-4 (DPP-4) inhibitors used in type 2 diabetes mellitus. Sitagliptin-associated BP is uncommon and may be complicated by secondary infections and multisystem involvement. A 74-year-old female with type 2 diabetes mellitus and hypertension presented with generalized weakness, burning micturition, abdominal pain, painful blistering skin lesions, and oral erosions. She had been receiving sitagliptin 100 mg once daily for approximately 2 years before symptom onset. Skin biopsy demonstrated a subepidermal bulla with eosinophilic infiltrates, suggestive of BP. Sitagliptin was discontinued after admission. The hospital course was complicated by bilateral pyelonephritis with multidrug-resistant urosepsis requiring bilateral double-J stenting, oral candidiasis caused by Candida albicans, recurrent gastrointestinal bleeding, and tubulovillous adenoma with high-grade dysplasia. Persistent dermatologic disease with markedly elevated immunoglobulin E levels necessitated omalizumab therapy, resulting in gradual improvement. Sitagliptin-associated BP should be considered in elderly diabetic patients presenting with blistering disorders after prolonged gliptin exposure. Early diagnosis, withdrawal of the suspected drug, histopathological confirmation, and multidisciplinary management are essential for favorable outcomes.

Emphysematous pyelonephritis (EPN) is a rare, life-threatening renal infection that is often associated with diabetes. This report describes a 59-year-old woman with neglected untreated type 2 diabetes who developed EPN caused by Escherichia coli and was complicated by sepsis and acute kidney injury (AKI). Unfortunately, the patient's condition deteriorated despite prompt conservative management with antibiotics, ureteral stenting, and strict glycemic control, as shown by imaging studies. Ultimately, laparoscopic right nephrectomy was performed, resulting in a clinical improvement and recovery. This case indicates that conservative management may fail even in lower-class EPN, particularly when risk factors such as thrombocytopenia and AKI are present.

Advanced HIV disease predisposes individuals to a wide and often concurrent spectrum of complications arising from opportunistic infections, immune dysregulation, direct viral injury, and treatment effects. In tuberculosis-endemic, resource-limited settings, disseminated tuberculosis frequently dominates clinical reasoning for multisystem disease in profoundly immunosuppressed patients - a cognitive default that risks failing to identify concurrent, independently treatable conditions. We describe a 35-year-old man with advanced HIV infection from central India who simultaneously developed parvovirus B19-associated marrow suppression, xanthogranulomatous pyelonephritis due to co-infection with carbapenem-resistant Escherichia coli and Mycobacterium chelonae, and symptomatic HIV-associated neurocognitive disorder (HAND) with myelopathy. To our knowledge, this represents the first reported case of M. chelonae pyelonephritis in a patient with HIV infection. This case report describes the diagnostic considerations for advanced HIV presenting as concurrent multisystem disease in a tuberculosis-endemic, resource-limited setting, and the clinical consequences of moving beyond the presumption of a single unifying aetiology.

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection that can affect the renal parenchyma, collecting system, or perinephric tissue. Although typically caused by enteric Gram-negative bacteria, infections secondary to Candida occur rarely. We present the case of a 72-year-old female who was transferred from an outside hospital with a chief complaint of abdominal pain in the setting of dislodged percutaneous nephrostomy tube for chronic hydronephrosis. Clinically, she presented without evidence of septic shock but was found to have elevated creatinine (6.04), concerning for acute renal failure. Urology was consulted and performed cystoscopy that showed a large bilateral mass consistent with fungal ball formation. Subsequent urine cultures speciated Candida tropicalis and Candida glabrata. Per infectious disease recommendations, the patient was initially started on treatment with fluconazole and flucytosine; however, fluconazole was switched to amphotericin B deoxycholate after sensitivities reported resistance to fluconazole for Candida tropicalis. Additionally, urology performed a bilateral percutaneous nephroscopy with ultrasonic lithotripsy for removal of her fungal bezoar on Day 22 of her hospitalization with subsequent nephrostograms that showed a patent genitourinary system. This case demonstrates successful treatment of EPN secondary to azole-resistant Candida species using combined systemic antifungal therapy and an endourologic approach. This avoided the use of percutaneous nephrostomy irrigation with amphotericin deoxycholate as recommended in current guidelines and prevented potential complications this procedure carries.

There are various radiopharmaceuticals and hybrid imaging techniques for evaluating pediatric patients in the acute care setting. The focus of this article is on common nuclear medicine applications in pediatric acute care. Brain scintigraphy is an important ancillary test for evaluation of brain death/death by neurologic criteria when the clinical examination or apnea test cannot be safely or completely performed. Ventilation-perfusion scintigraphy is considered as a safe and useful test for suspected pulmonary embolism in hemodynamically stable children, especially when the chest radiograph is normal or near normal and radiation reduction is important. 99mTc-pertechnetate scintigraphy is stated to be the best noninvasive nuclear medicine test for detecting ectopic gastric mucosa in Meckel's diverticulum, whereas 99mTc-labeled red blood cell scintigraphy is useful for evaluating active or intermittent lower gastrointestinal bleeding from different causes. Hepatobiliary scintigraphy provides functional assessment of biliary excretion and is useful for evaluation of acute cholecystitis, choledochal cysts, and bile leaks. 99mTc-DMSA renal cortical scintigraphy is a sensitive method for detecting acute pyelonephritis and renal cortical scarring, while 99mTc-MAG3 renal scintigraphy is used to evaluate early and late complications of renal transplantation. Bone scintigraphy is considered as a valuable imaging modality for evaluation of osteomyelitis, occult fracture, stress injury, sickle cell related bone pain, and selected cases of suspected physical abuse, especially when whole body assessment is needed. 18F-FDG PET/CT has an increasing role in selected children with fever of unknown origin and inflammatory disorders. Moving forward, continued refinement of pediatric administered activities, wider use of SPECT/CT and PET-based imaging and updated pediatric-specific guidelines are expected to further improve the role of nuclear medicine in acute pediatric care.

The long-term renal implications of conditions leading to male reproductive surgeries remain unclear. This study evaluated the potential causal relationships between genetic liability to undergoing these surgeries and kidney diseases. Genetic variants associated with four surgery-related phenotypes-testicular hydrocele surgery, testicular or scrotal surgery, circumcision, and vasectomy-were selected as instrumental variables. Mendelian randomization, meta-analysis, and exploratory mediation analyses were used to assess associations with 20 kidney outcomes. Results showed genetic liability to testicular hydrocele surgery was associated with higher odds of chronic kidney disease, IgA nephropathy, glomerulonephritis, cystic kidney disease, tubulo-interstitial nephritis, and kidney injury, and with lower odds of benign kidney tumors and renal stones. Genetic liability to testicular or scrotal surgery was associated with increased odds of renal colic, gout, malformations of the renal pelvis or ureters, renal stones, and kidney infections. Genetic liability to circumcision was associated with higher odds of congenital obstructive malformations, hypertensive heart/renal disease, malignant kidney neoplasms, and increased kidney volume, and with lower odds of kidney cysts, benign tumors, and chronic renal failure. Genetic liability to vasectomy was linked to reduced odds of pyelonephritis and malignant kidney neoplasms. Mediation analyses suggested partial contributions of immune and metabolic traits. This study provides evidence that genetic liability to undergoing male reproductive system surgeries-reflecting the underlying biological or pathological indications-is associated with distinct patterns of kidney disease susceptibility. Findings suggest that individuals with underlying conditions predisposing them to testicular hydrocele or scrotal surgery may benefit from attention to long-term kidney health.