Myroides spp. Causing Urinary Tract Infection in an Immunocompromised Patient: A Case Report

Abstract

A 12 year old girl presented to the paediatric OPD with complains of generalised swelling and decreased urine output for the past ten days. The swelling started from the face followed by the abdomen and limbs. The patient also had cough, difficulty in breathing and episodes of vomiting for the past 2 days. The vomiting was non-bilious and nonprojectile. There was no history of fever, pain abdomen, loose stools, burning micturition or haematuria. There was no history of headache, or any evidence of focal neurological defect. On examination her blood pressure was found to be raised. Her cardiovascular and motor system functions were found to be within normal limits. On per abdomen examination, abdomen was found to be soft and distended, no organomegaly found and bowel sounds were normal. Her haemogram was within normal limits, ANA was negative. Chest Xray showed signs of pleural effusion and pleural fluid was negative for TB by Genexpert. Her C3 and C4 complement levels were within normal limits. On urine analysis showed protein to creatinine ratio of 2.57. Urine dipstick showed-albumin (3+) and sugar (nil). Serum protein was 3.5-4 g/dl (normal: 6-8.3 g/dl) and serum albumin 1.3-1.5 g/dl (3.5-5 g/dl). Her total blood cholesterol was 912 mg/dl (normal <200 mg/dl). The patient had hypoalbuminemia, hyper albuminuria, hyperlipidemia and generalised edema, thus a presumptive diagnosis of nephrotic syndrome was made.