Acute Kidney Failure and Minimal Change Disease

Meyrier, Alain; Niaudet, Patrick

doi:10.1007/978-1-4939-8628-6_11

Cited by 1 publication

(1 citation statement)

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“…Prostatic abscesses are relatively rare; immunocompromised individuals are more susceptible and typically present with nonspecific symptoms, which pose diagnostic challenges resulting in delayed diagnosis and late treatment, causing the morbidity and mortality of this condition. 5 A high level of clinical suspicion, particularly in high-risk and nonresponding individuals, is required for early diagnosis, timely treatment, and optimal outcomes. 6 Elshal et al reported 42 patients of prostatic abscess who were admitted for active interventional treatment of whom 24% were on immunosuppressive treatment secondary to a renal/liver transplant.…”

Section: Discussionmentioning

confidence: 99%

Febrile Immunocompromised Renal Transplant Recipient with Allograft Dysfunction: Detection of an Undiagnosed Prostate Abscess by [18F]FDG-PET/CT along with Treatment Response Monitoring

Sonavane,

Jamale,

Bose

et al. 2024

World J Nucl Med

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The purpose of this report is to provide a comprehensive description of a post-transplant febrile patient's clinical course, complications, surgical procedure, and long-term management including evaluation by 18F-fluorodeoxyglucose [(18F)FDG] positron-emission tomography combined with computed tomography (PET/CT). A 35-year-old male, a postrenal transplant patient, developed chronic allograft dysfunction and presented with fever with chills, with suspicion of acute-on-chronic graft dysfunction, but no infective focus localization on chest X-ray, ultrasonography (USG) whole abdomen, or blood culture. Urine microscopy showed 8 to 10 pus cells/high-power field (hpf) and culture showed Klebsiella pneumoniae and Pseudomonas aeruginosa with low colony count. Culture-sensitive antibiotics were prescribed for 2 weeks, and after 3 weeks febrile episodes relapsed, symptoms progressed, and required emergency hospitalization due to acute painful urinary retention. Proteinuria and no growth were noted in urine analysis, serum creatinine was 5.36 mg/dL, and C-reactive protein was 15.7mg/dL, and remaining parameters were unremarkable. [18F]FDG-PET/CT was considered in order to resolve diagnosis, which revealed abnormal heterogeneous tracer uptake in the enlarged prostate with hypodense areas within, suggesting prostatitis with abscess formation and pyelonephritis in the upper pole of the transplant kidney. USG kidney urinary bladder (KUB) correlation confirmed prostatic abscess and transurethral drainage done, and pus culture revealed Burkholderia pseudomallei. Culture-sensitive intravenous meropenem treatment was given for 3 weeks. At 5 weeks, follow-up [18F]FDG-PET/CT showed low metabolic residual prostate uptake, suggesting a good response with residual infection. Thus, intravenous antibiotics was changed to oral antibiotics for another 6 weeks. His symptoms completely resolved at the end of treatment; however, his graft function worsened, with serum creatinine reaching 6 to 7 mg/dL, and eventually, after 8 months he became dialysis dependent.

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Section: Discussionmentioning

confidence: 99%