Successful eradication of renal allograft abscess by CT-guided percutaneous pigtail drainage: A case report

Abstract

Rationale: Renal allograft abscess is an infrequent complication in kidney transplant recipients. The mainstay of treatment is adequate drainage and optimal antibiotic administration. Patient Concerns: A 25-year-old female who presented with dysuria, frequency, chills, fever, and allograft pain was initially diagnosed with a urinary tract infection complicated by septic shock 15 months after kidney transplantation. Ultrasound depicted a hypoechoic mass and contrast-enhanced computed tomography (CT) revealed a lesion with no enhancement in the renal allograft. CT-guided percutaneous pigtail drainage placement was implemented. Diagnoses: Blood-stained pus was aspirated from the lesion in the renal allograft. The aspirate culture revealed Escherichia coli and Proteus mirabilis with an antibiogram consistent to urine culture. The diagnosis of renal allograft abscess originated from urinary tract infection was confirmed. Interventions: The patient underwent CT-guided percutaneous pigtail drainage and conducted culture of the aspirate. Outcomes: The patient’s symptoms immediately abated after drainage and renal allograft function recovered normally. Ultrasound and CT showed total regression of the renal allograft abscess at the 1-month outpatient follow-up. Lessons: Heightened alertness should be attached to that severe urinary tract infections presenting with sepsis shock and antibiotic treatment non responders are likely to progress to renal allograft abscess in kidney transplant recipients. CT-guided percutaneous pigtail drainage was a safe and effective minimally invasive treatment.

Successful treatment of a renal allograft abscess with antimicrobial agents alone and appropriate follow‐up imaging

“…UTIs are associated with an elevated risk of mortality 1 . In addition, it is crucial to consider renal allograft abscesses when recurrent pyelonephritis or unresolved fever is observed despite antibiotic treatment 2–4 . Delayed diagnosis for renal abscesses can result in significant morbidity and mortality 5 .…”

“…Nevertheless, these studies were limited to autologous renal abscesses, and there are currently no clear treatment guidelines for abscesses in transplanted kidneys. Although a few reports have suggested that CT‐ or ultrasound‐guided percutaneous drainage may be effective in managing renal abscesses in transplanted kidneys, 2–4 this approach may be challenging depending on the location of the abscess. Furthermore, there is no fixed duration of antimicrobial therapy for renal abscesses.…”

“…1 In addition, it is crucial to consider renal allograft abscesses when recurrent pyelonephritis or unresolved fever is observed despite antibiotic treatment. [2][3][4] Delayed diagnosis for renal abscesses can result in significant morbidity and mortality. 5 The diagnosis is typically established through imaging studies, such as ultrasonography and contrast-enhanced computed tomography (CT).…”

“…Although a few reports have suggested that CT-or ultrasound-guided percutaneous drainage may be effective in managing renal abscesses in transplanted kidneys, [2][3][4] this approach may be challenging depending on the location of the abscess. Furthermore, there is no fixed duration of antimicrobial therapy for renal abscesses.…”