Gardnerella vaginalis in women causes vaginitis or infections in other sites, such as the urinary tract, but is an infrequent cause of bacteremia. Bacteremia in men is very rare and is typically associated with immunocompromised states. Here we describe G. vaginalis bacteremia in a previously healthy man with renal calculi and urosepsis.
CASE REPORTA 41-year-old male roofer with no prior medical problems presented with sudden onset of left flank pain. The pain was colicky in nature and not accompanied by fever, chills, urgency, or dysuria. A physical examination at the time of presentation was unremarkable. A computed tomography scan of the abdomen revealed a 6.5-mm kidney stone in the midpole of the kidney and a 3-mm calculus at the left vesicoureteric junction. Obstructive uropathy and perinephric stranding were noted. Urine biochemistry revealed slight hemoglobinuria. The patient underwent ureteroscopy the following day, and as no infection was thought to be present, no antibiotics were given. The distal ureteric calculus was not seen and was assumed to have passed spontaneously. Follow-up imaging demonstrated only the larger proximal stone. The patient was discharged from the hospital, but he returned 2 days later with worse flank pain. The computed tomography scan was repeated, and it demonstrated a 4-mm stone in the proximal left ureter, with small fragments remaining in the midpole of the kidney. Additional investigations revealed a leukocyte count of 16.0 ϫ 10 9 cells/liter (normal range, 4 ϫ 10 9 to 11 ϫ 10 9 cells/liter) with a predominance of neutrophils (absolute count, 12.6 ϫ 10 9 cells/ liter; normal count, 2 ϫ 10 9 to 5 ϫ 10 9 cells/liter). Creatinine was elevated at 148 mol/liter (normal range, 70 to 110 mol/ liter). The patient was readmitted for a repeat ureteroscopy. Prior to this procedure, the patient was febrile, with a temperature of 39.1°C and rigors. He appeared well otherwise, and his physical examination, including blood pressure, was unremarkable. Ciprofloxacin (400 mg intravenously every 12 h) was empirically started for presumed urosepsis. The patient's complete blood count was normal, and cultures of urine and blood (two sets, with 20 ml from one site for anaerobe and aerobic cultures and 10 ml from a second site for an aerobic bottle) were taken prior to initiation of antimicrobial therapy. The quantitative urine culture revealed 6.5 ϫ 10 7 CFU/liter of a ciprofloxacin-sensitive strain of Escherichia coli. On the fifth day of incubation, the aerobic blood culture from the first set was flagged positive by the automated BacT/Alert system. A subculture of the second blood culture set revealed the same organism. The hospital laboratory was unable to achieve a definitive identification of the blood culture isolate, so the isolate was sent to a reference center.The patient underwent a repeat ureteroscopy with lithotripsy and an extraction of the proximal stone. A ureteric stent was inserted, and it was removed the following week. The patient was treated with a 10-day course of oral cip...