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Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report.
BMC Infect Dis 2020; 20(1):47BI

Abstract

BACKGROUND

Ureaplasma urealyticum is a fastidious bacteria which lacks a cell wall. Extragenital infections are rare in immunocompetent adults. There are few literature reports of perinephric abscess. We present a case of non-resolving multifocal "culture-negative" abscesses in a hypogammaglobulinemic adult female due to U. urealyticum.

CASE PRESENTATION

66-year-old female with a one-week history of fever, malaise and new right hip and leg pain. Past medical history was notable for chronic pancytopenia secondary to in remission B cell follicular lymphoma, ESRD on intermittent hemodialysis with bilateral nephrostomy tubes and Crohn's. CT abdomen/pelvis revealed a small left perinephric hematoma and proximal right femur fluid collection. Persistent right thigh pain led to additional ultrasound with anterior thigh collection and CT revealed an irregular rim-enhancing fluid collection in the left posterior pararenal space. Antimicrobial therapy included ertapenem and vancomycin followed by meropenem, trimethoprim-sulfamethoxazole, daptomycin and metronidazole in setting of persistent culture-negative results and clinical deterioration. Following detection of U. urealyticum by 16S rDNA PCR in both left pararenal and right trochanteric bursa abscesses doxycycline was started. Despite this, the patient died four days later.

CONCLUSIONS

Disseminated infection by U. urealyticum has been documented in immunocompromised adult patients with few reports of perinephric abscess. We propose that ascending genitourinary route led to perinephric abscess. The multiple disseminated fluid collections make it highly suspicious for hematogenous spread given the lack of radiographic enhancement to suggest contiguous spread. Diagnosis and treatment of U. urealyticum-disseminated infection is extremely challenging as culture is laborious and not routinely performed. Furthermore, the lack of cell wall renders beta-lactams and vancomycin ineffective and therefore requirement for "atypical" coverage. Early diagnosis and treatment are key to prevent further complications and death.

Authors+Show Affiliations

University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada. carolina.diazpallares@ahs.ca.University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31941460

Citation

Diaz Pallares, Carolina, et al. "Ureaplasma Urealyticum Disseminated Multifocal Abscesses in an Immunocompromised Adult Patient: a Case Report." BMC Infectious Diseases, vol. 20, no. 1, 2020, p. 47.
Diaz Pallares C, Griener T, Vaughan S. Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report. BMC Infect Dis. 2020;20(1):47.
Diaz Pallares, C., Griener, T., & Vaughan, S. (2020). Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report. BMC Infectious Diseases, 20(1), p. 47. doi:10.1186/s12879-020-4771-z.
Diaz Pallares C, Griener T, Vaughan S. Ureaplasma Urealyticum Disseminated Multifocal Abscesses in an Immunocompromised Adult Patient: a Case Report. BMC Infect Dis. 2020 Jan 15;20(1):47. PubMed PMID: 31941460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report. AU - Diaz Pallares,Carolina, AU - Griener,Thomas, AU - Vaughan,Stephen, Y1 - 2020/01/15/ PY - 2019/10/08/received PY - 2020/01/07/accepted PY - 2020/1/17/entrez PY - 2020/1/17/pubmed PY - 2020/1/17/medline KW - Adult patient KW - Case report KW - Multifocal abscesses KW - Ureaplasma urealyticum SP - 47 EP - 47 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 20 IS - 1 N2 - BACKGROUND: Ureaplasma urealyticum is a fastidious bacteria which lacks a cell wall. Extragenital infections are rare in immunocompetent adults. There are few literature reports of perinephric abscess. We present a case of non-resolving multifocal "culture-negative" abscesses in a hypogammaglobulinemic adult female due to U. urealyticum. CASE PRESENTATION: 66-year-old female with a one-week history of fever, malaise and new right hip and leg pain. Past medical history was notable for chronic pancytopenia secondary to in remission B cell follicular lymphoma, ESRD on intermittent hemodialysis with bilateral nephrostomy tubes and Crohn's. CT abdomen/pelvis revealed a small left perinephric hematoma and proximal right femur fluid collection. Persistent right thigh pain led to additional ultrasound with anterior thigh collection and CT revealed an irregular rim-enhancing fluid collection in the left posterior pararenal space. Antimicrobial therapy included ertapenem and vancomycin followed by meropenem, trimethoprim-sulfamethoxazole, daptomycin and metronidazole in setting of persistent culture-negative results and clinical deterioration. Following detection of U. urealyticum by 16S rDNA PCR in both left pararenal and right trochanteric bursa abscesses doxycycline was started. Despite this, the patient died four days later. CONCLUSIONS: Disseminated infection by U. urealyticum has been documented in immunocompromised adult patients with few reports of perinephric abscess. We propose that ascending genitourinary route led to perinephric abscess. The multiple disseminated fluid collections make it highly suspicious for hematogenous spread given the lack of radiographic enhancement to suggest contiguous spread. Diagnosis and treatment of U. urealyticum-disseminated infection is extremely challenging as culture is laborious and not routinely performed. Furthermore, the lack of cell wall renders beta-lactams and vancomycin ineffective and therefore requirement for "atypical" coverage. Early diagnosis and treatment are key to prevent further complications and death. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/31941460/Ureaplasma_urealyticum_disseminated_multifocal_abscesses_in_an_immunocompromised_adult_patient:_a_case_report L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-4771-z DB - PRIME DP - Unbound Medicine ER -