Renal abscess due to Pseudomonas aeruginosa: report of two cases.

We report two cases of renal abscess due to Pseudomonas aeruginosa in previously healthy children. The first patient was a nine-year old girl with a three-week history of intermittent fever and the second was a three-year old boy with a four-day history of fever. Pseudomonas aeruginosa was isolated from the urine cultures of both children. In both cases ultrasound and CT/MRI scans revealed the formation of a renal abscess. The patients were successfully treated with administration of antipseudomonal drugs for seven and five weeks, respectively. In both children no surgical intervention was required and the follow-up revealed no impact on the overall renal function or arterial pressure.

False-positive urine beta-HCG in a woman with a tubo-ovarian abscess.

Modern urine beta-human chorionic gonadotropin (HCG) assays that use enzyme-linked immunosorbent assay (ELISA) technology are sensitive and specific for diagnosing pregnancy, both intrauterine and ectopic, and have become indispensable to the practice of Emergency Medicine. A urine HCG test is often relied on by the Emergency Physician as a critical component in the diagnostic regimen of a patient with a possible ectopic pregnancy. We report a case of a false-positive urine beta-HCG test in a patient with a ruptured tubo-ovarian abscess. Though false-positive pregnancy tests with tubo-ovarian abscesses have previously been reported with older methods of HCG detection, we believe that this is the first case where the pregnancy test was the modern ELISA type. The mechanism for the false-positive reaction in this case is unknown, but time may show that the ELISA test kit, like its predecessors, may occasionally give a false-positive reaction in this class of patients.

Clinical spectrum of urinary tract infections due on nontyphoidal Salmonella species.

We performed a retrospective analysis of 28 cases of bacteriuria due to nontyphoidal Salmonella (NTS). Twenty-one patients (75%) had symptoms of urinary tract infection (16, cystitis; 3, pyelonephritis; and 2, renal abscess), and 7 remained asymptomatic. In 24 cases NTS was the sole pathogen isolated from urine. Salmonella enteritidis (a Salmonella subgroup 1 serotype) was the serotype most frequently isolated (16 cases), followed by Salmonella enteritidis serotype typhimurium (5 cases). Sixteen patients (57%) were severely immunocompromised, and 14 (52%) had urologic abnormalities. Recurrence of bacteriuria occurred in four patients. It is suggested that in cases of urinary salmonellosis one must consider the existence of an occult urologic problem or severe immunosuppression.

Hematuria caused by abdominal abscessation in a foal.

A 4.5-month-old Standard-bred filly was referred for evaluation of pigmenturia. Initially, the pigmenturia had resolved with the administration of antibiotics, only to recur after their withdrawal. A dark red urine sample contained numerous RBC, WBC, and gram-negative rods (Escherichia coli). Ultrasonography revealed the right kidney to be large, with multiple cystic structures and a dilated renal pelvis and calices. Cystoscopy revealed a large blood clot within the bladder and urine coming from the left ureteral opening. Urine was not observed coming from the right ureter. It was suspected that the primary infection within the urinary tract was coming from the right kidney, with secondary ureteral obstruction and cystitis. Trimethoprim-sulfamethoxazole treatment was initiated. However, acute depression and abdominal pain developed several days later, and the foal died before assistance could be provided. Necropsy revealed a large abscess that had eroded into the right ureter and aorta and had ruptured, resulting in acute blood loss and death. The location and extensive nature of the lesion would have precluded surgical intervention.

[Radiological diagnosis of acute kidney abscess in adults. Early diagnosis apropos of 7 cases]. / Le diagnostic radiologique des abcès aigus du rein de l'adulte. Diagnostic précoce à propos de 7 cas

The authors report, in 7 cases, their experience of the early diagnosis of renal abscess. They emphasize the importance of recognising this disease by comparison of the findings of intra-venous urography and the clinical signs. They were thus able to avoid arteriography and surgical operation in 6 cases. The diagnosis depends on the finding of a mass in the right kidney (5 cases out of 7) on intravenous urography, usually in the upper pole (4 cases out of 7). This space-occupying lesion may be accompanied by a certain number of signs which are inconstant and not specific, e.g. disappearance of the normal calyx pattern which disappears under compression and is probably related to inflammation. In fact, this association of a tumour and fever, due to deep pus formation and urinary infection, suggests the diagnosis and leads to the prescription of antibiotics. The disapperance of the clinical and radiological négative signs within 10 days confirms the diagnosis. The persistence of the space-occupying lesion requires arteriography which will make the difference between chronic abscess and carcinoma.