Intrarenal Abscesses Due to Ureaplasma urealyticum in a Transplanted Kidney

Abstract

A young woman developed multiple abscesses in her transplanted kidney. Amplification of the 16S rRNA gene with subsequent sequencing revealed Ureaplasma urealyticum as the infectious agent. Microbiological diagnosis and sensitivity testing led to therapy with levofloxacin, resulting in rapid recovery of the patient. CASE REPORTA 19-year-old young woman presented with abdominal pain, dysuria, macrohematuria, loss of weight (5 kg during the previous 6 weeks), and general fatigue. She had a history of juvenile nephronophthisis (diagnosed at the age of 9 years), leading to kidney transplantation at the age of 11. Transplant function was excellent, and primary immunosuppression therapy included tacrolimus and prednisolone. The patient was diagnosed with a posttransplant lymphoproliferative disease 6 years later. Histology showed a B-cell lymphoma, and immunosuppression therapy was reduced and switched to sirolimus (5 mg/kg/day) and prednisolone (5 mg/day). The patient also received four doses of rituximab (600 mg each). The posttransplant lymphoproliferative disease regressed rapidly, and the patient had no further evidence of recurrence during 2 years of follow-up. One month prior to presentation, a unilateral ovariectomy was performed because of a bleeding ovarian cyst. The patient had never experienced urinary tract infections.Laboratory investigations showed an elevated serum creatinine level (1.63 mg/dl; previous baseline, 0.8 mg/dl), a slightly elevated C-reactive protein (CRP) level (2.1 mg/dl), and massive leucocyturia (1,000 white blood cells [WBC]/l). The differential WBC analysis showed a shift to the left (rods, 11%; segmented neutrophils, 63%; lymphocytes, 34%; eosinophils, 2%; basophils, 1%), but the total WBC count was not elevated (9.15/nl); the hemoglobin level was 9.0 mg/dl. Immunosuppression therapy at this time consisted of sirolimus (trough level, 17 ng/ml; highly elevated) and prednisolone (5 mg/day).The ultrasound of the kidney transplant showed multiple abscesses (maximal diameter, 0.5 cm) which were diffusely distributed throughout the whole kidney (Fig. 1).With the diagnosis of transplant pyelonephritis with intrarenal bacterial abscess formations, the patient was treated with ampicillin (120 mg/kg/day) and ceftazidime (90 mg/kg/day) for 3 weeks. However, the patient did not respond to this therapy and developed persistent hyperthermia up to 40°C with little response to antipyretics. The CRP level rose to 10 mg/dl, and the intrarenal abscess formations showed an increase in volume up to Ø of 2 cm, while the serum creatinine increased to 2.9 mg/dl; urine output was sufficient at all times. After 10 days of treatment, the general condition of the young woman had not improved, and antibiotic therapy was supplemented with imipenem/cilastin (40 mg/kg/day).Repeated cultures of blood and urine remained sterile with conventional culture methods. Puncture of three abscesses resulted in purulent material. On microbiological examination, cultures for aerobic and anaerobic bacteria, fungi, and mycobacte...

Ureaplasma and Mycoplasma in kidney allograft recipients—A case series and review of the literature

“…Analysis of aspirate from the abscess using molecular methods revealed U. urealyticum, while cultures for aerobic and anaerobic bacteria, mycobacteria, and fungi as well as PCR for Mycobacterium tuberculosis were negative. Possible contributing factors for the abscess formation identified in this case were a high sirolimus level and previous administration of rituximab, although the lymphocyte blood counts and T‐cell subsets at the time were reported as normal . Interestingly, our patient also developed PTLD more than 1 year after treatment of her U. urealyticum infection.…”

Severe hematuria in a hematopoietic cell transplant recipient caused by Ureaplasma urealyticum not by BK virus or adenovirus infection

“…We reviewed literatures online with keywords [ Ureaplsma , cystitis], [ Ureaplsma , pyelonephritis] and [ Ureaplasma , hematuria]. There were several reports described U. urealyticum UTI in patient with immunocompromised condition such as hypogammaglobulinemia or patients who received rituximab treatment (Table ) . To the best of our knowledge , gross hematuria after HCT due to U. urealyticum infection has never been reported previously.…”

Serum killing of Ureaplasma parvum shows serovar-determined susceptibility for normal individuals and common variable immuno-deficiency patients

“…Ureaplasma are the smallest identified free-living bacteria and opportunistic pathogens for patients with underdeveloped immune systems such as preterm neonates (Waites et al 2009), as well as the immune compromised host such as hypogammaglobulinaemic patients (Furr et al 1994;Taylor-Robinson et al 1985) or those receiving immunosuppressive therapy following organ transplantations (Eilers et al 2007;Ekiel et al 2009). Ureaplasma are small pleomorphic bacteria that are closely related to Mycoplasma and are part of the class Mollicutes.…”