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Because of the rarity of anaerobic infections of the urinary tract and the difficulty of establishing these organisms as pathogens, anaerobic culture is not included as part of routine urine bacteriological examination. Pyuria was found during examination of a 41-year-old man with a chronic renal allograft rejection reaction. Aerobic urine cultures failed to yield any pathogens. Urine cytology demonstrated intracellular organisms that proved to be Fusobacterium nucleatum on anaerobic culture. The serotypically identical organism was isolated from a needle biopsy specimen of the renal allograft. In the presence of pyuria the finding of micro-organisms in the urine sediment that fail to grow on routine aerobic cultures should lead to examination for anaerobic bacterial infection of the urinary tract.

A 43-yr-old man with a 19-yr history of Wegener's granulomatosis presented with recurrent haematuria, pulmonary infiltrate, cutaneous vasculitis, nasal mucosal involvement and elevation of ANCA levels, 2 yr following successful cadaveric renal transplantation, despite continued immunosuppressive therapy with cyclosporine, azathioprine and prednisone. Re-introduction of cyclophosphamide therapy resulted in prompt resolution of clinical and laboratory abnormalities. The superiority of cyclophosphamide over cyclosporine for maintaining suppression of Wegener's granulomatosis is substantiated in a critical review of the literature.

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