Encrusted Cystitis in an Immunocompromised Patient: Possible Coinfection by Corynebacterium Urealyticum and E. Coli

Abstract

Encrusted cystitis is a severe chronic inflammatory disease of the bladder characterized by excessively alkaline urine and calcifications within the bladder wall. A case of a 60 year-old man affected by systemic lupus erythematosus (SLE), which developed encrusted cystitis due to Corynebacterium urealyticum with E. coli coinfection, shows that the treatment of encrusted cystitis with a endoscopic debulking of the encrusted stones and an antimicrobial therapy specific for C. urealyticum often is not sufficient for the complete resolution of symptoms.C. urealyticum is a Gram-positive, slow-growing, multiresistant, urease-positive microorganism with diphtheroid morphology. Since 1985 it has been known as a cause of alkaline encrusted cystitis and other urinary tract infections (1), occurring mainly in patients subjected to urological manipulation. Alkaline encrusted cystitis is a condition characterized by the deposition of inorganic salts on a damaged urothelium. The patient presents symptoms of cystitis (2). Moreover C. urealyticum has been involved in endocarditis, pneumonia, peritonitis, osteomyelitis and soft-tissue infections (3). We report a case of encrusted cystitis due to Corynebacterium urealyticum in a patient with SLE. MATERIALS AND METHODSA 60 year-old man, affected by SLE and in treatment with steroid therapy, presents with persistent symptoms of urinary tract infection including dysuria, pollakiuria, and intermittent hematuria with urinary gravel. He had undergone cystoscopy, which showed stone deposits in the bladder wall. Analysis of the urinary stone deposits on the bladder mucosa revealed the presence of ammonium magnesium phosphate (struvite) and calcium hydroxy phosphate (apatite).The urine sample was plated onto modified MacConkey agar (Oxoid) and CLED (cystine-Iactoseelectrolyte-deficient) agar and incubated at 37°C for 48 h. The identification and the antibiotic sensitivity testing for common pathogen germs were performed with the Phoenyx identification system (Becton Dickinson, USA). The urine and pus culture for Corynebacterium spp. on 7% sheep blood agar (Oxoid, England) was performed with incubation at 37°C in air for 24 h. The microbiological criteria for identification of C. urealyticum were the presence of gram-positive bacteria with diphtheroid morphology catalase-positive and strongly urease-positive. For identification the APICoryne identification strip (API Laboratory' Products; bio-Merieux, France) and the Phoenyx identification system (Becton Dickinson, USA) were utilised. The

Inflammatory cytokines and S-100b protein in patients with hepatitis C infection and cryoglobulinemias

“…In this study, patients were considered to have a significant amount of serum cryoglobulins if they had a minimum level of 0.05 g/l on two occasions. According to the classification of Brouet et al 3 all patients had either type II or type III MC.…”

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Successful treatment of encrusted cystitis: A case report and review of literature

“…It has been reported that there are more than 40 types of urease-producing bacteria that can cause EC, and C. urealyticum is the most common[ 1 , 3 , 7 - 9 , 11 , 16 , 20 - 22 ]. C. urealyticum is a common skin colonizer of hospitalized elderly individuals who are receiving broad spectrum antibiotics.…”