Pasteurella multocida Perinephric Abscess After Renal Transplantation

Abstract

A 67-year-old man was noted to have an elevated serum creatinine 5 months after renal transplantation. Ultrasonography revealed a large fluid collection around the allograft kidney. Aspirated fluid and blood cultures grew Pasteurella multocida. After a failed trial of intravenous antibiotics and percutaneous catheter drainage, the abscess finally resolved after open surgical drainage and a prolonged antibiotic course. The patient had sustained a cat scratch 2 weeks before presentation. (Infect Dis Clin Pract 2007;15:196-198) F luid collections develop around renal allografts in 20% to 51% of cases. 1 These may be lymphoceles, hematomas, urinomas, or abscesses. Lymphoceles usually form weeks to months after transplantation surgery and are due to disruption of recipient iliac lymphatics with variable contributions from lymphatics of the allograft kidney. 2 Urinomas arise from urine leakage due to ureteral ischemia and necrosis or acute leakage at the anastomotic site. 3 Abscesses may arise from extension of surgical wound infections or from secondary infection of lymphoceles, hematomas, or urinomas; they account for 2% to 30% of all aspirated fluid collections in the early posttransplant period. 1 The most common bacterial etiologies of periallograft renal abscesses include Staphylococcus aureus, enteric gram-negative bacilli and bacteroides species. 4 This report describes what we believe is the first case of P. multocida bacteremia and periallograft abscess in a patient who had undergone renal transplantation. CASE REPORTA 67-year-old man with kidney failure secondary to Goodpasture syndrome underwent renal transplantation in November 2004 from a living, unrelated donor. His pretransplantation panelreactive-antigen was 17%, and he shared a 4-antigen match with the donor. After transplantation, he was maintained on mycophenolate, cyclosporine, and prednisone for chronic immunosuppression but did not receive induction therapy. He did well until 5 months posttransplantation, when his serum creatinine was noted to have increased to 1.7 mg/dL from a posttransplant baseline of 1.3 mg/dL. Ultrasound imaging of the transplanted kidney revealed an adjacent fluid collection measuring 13.2 Â 7.6 cm, and he was admitted to the hospital. His only complaint at that time was fatigue during the previous 2 weeks. His medications included mycophenolate (1 g BID), cyclosporine (150 mg BID), and prednisone (15 mg daily). He was a healthy-appearing man with normal vital signs. The physical examination was unremarkable, with a completely healed abdominal surgical incision. Laboratory data at admission were as follows: white blood cell count, 14,700/mL (90% granulocytes and 10% lymphocytes); hemoglobin level, 8.3 g/dL; platelet 431,000/mL; serum urea nitrogen, 45 mg/dL; and creatinine, 1.7 mg/dL. The rest of a serum chemistry panel, including liver-associated enzymes, was normal. A chest radiograph was normal. A computerized tomographic (CT) scan of the abdomen showed a 13 Â 9-cm fluid collection anteromedial to the allograft kidney...