Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele

A 14-year-old girl noticed malodorous urine and experienced left flank pain. The patient was presented to our hospital with gradually increasing pain. She had no underlying disease but had a history of pain on micturition for several days. Hematologic examination indicated low white blood cell and p...

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Autores principales:	Hiroyuki Kitano, Keisuke Hieda, Hiroki Kitagawa, Yusuke Nakaoka, Yumiko Koba, Kohei Ota, Norifumi Shigemoto, Tetsutaro Hayashi, Seiya Kashiyama, Jun Teishima, Nobuaki Shime, Hiroki Ohge, Nobuyuki Hinata
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	emphysematous pyelonephritis congenital ureterocele children Actinotignum schaalii Peptoniphilus asaccharolyticus Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/e0255ff7332d4699b7cbed49109c0228
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spelling	oai:doaj.org-article:e0255ff7332d4699b7cbed49109c02282021-12-01T07:28:03ZCase Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele2296-236010.3389/fped.2021.775468https://doaj.org/article/e0255ff7332d4699b7cbed49109c02282021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.775468/fullhttps://doaj.org/toc/2296-2360A 14-year-old girl noticed malodorous urine and experienced left flank pain. The patient was presented to our hospital with gradually increasing pain. She had no underlying disease but had a history of pain on micturition for several days. Hematologic examination indicated low white blood cell and platelet counts and a high serum lactate level. Computed tomography showed that a part of the parenchyma of the left kidney had poor contrast and was deteriorated, with fluid and gas retention from the perirenal region to the retroperitoneal cavity. A left hydroureter and large ureterocele were observed in the bladder. She was diagnosed with emphysematous pyelonephritis (EPN) with a giant congenital ureterocele. Vasopressors and blood transfusion failed to maintain normal circulatory dynamics, and an open left nephrectomy and transurethral ureterocele fenestration were performed. The excised outer portion of the left kidney was dissolved by the infection and replaced with blood clots and necrotic tissue. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified the inflammatory, gas-producing bacteria Actinotignum schaalii, Peptoniphilus asaccharolyticus, and Actinomyces odontolyticus. Meropenem was administered for 4 days postoperatively and then de-escalated to sulbactam/ampicillin for another 10 days. The patient was discharged on day 17 of hospitalization, and the postoperative course remained favorable. EPN is extremely rare in pediatric patients, and it is believed that nephrectomy is sometimes necessary if the patient does not have normal circulatory dynamics despite the use of catecholamines.Hiroyuki KitanoKeisuke HiedaHiroki KitagawaYusuke NakaokaYumiko KobaKohei OtaNorifumi ShigemotoTetsutaro HayashiSeiya KashiyamaJun TeishimaNobuaki ShimeHiroki OhgeNobuyuki HinataFrontiers Media S.A.articleemphysematous pyelonephritiscongenital ureterocelechildrenActinotignum schaaliiPeptoniphilus asaccharolyticusPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	emphysematous pyelonephritis congenital ureterocele children Actinotignum schaalii Peptoniphilus asaccharolyticus Pediatrics RJ1-570
spellingShingle	emphysematous pyelonephritis congenital ureterocele children Actinotignum schaalii Peptoniphilus asaccharolyticus Pediatrics RJ1-570 Hiroyuki Kitano Keisuke Hieda Hiroki Kitagawa Yusuke Nakaoka Yumiko Koba Kohei Ota Norifumi Shigemoto Tetsutaro Hayashi Seiya Kashiyama Jun Teishima Nobuaki Shime Hiroki Ohge Nobuyuki Hinata Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele
description	A 14-year-old girl noticed malodorous urine and experienced left flank pain. The patient was presented to our hospital with gradually increasing pain. She had no underlying disease but had a history of pain on micturition for several days. Hematologic examination indicated low white blood cell and platelet counts and a high serum lactate level. Computed tomography showed that a part of the parenchyma of the left kidney had poor contrast and was deteriorated, with fluid and gas retention from the perirenal region to the retroperitoneal cavity. A left hydroureter and large ureterocele were observed in the bladder. She was diagnosed with emphysematous pyelonephritis (EPN) with a giant congenital ureterocele. Vasopressors and blood transfusion failed to maintain normal circulatory dynamics, and an open left nephrectomy and transurethral ureterocele fenestration were performed. The excised outer portion of the left kidney was dissolved by the infection and replaced with blood clots and necrotic tissue. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified the inflammatory, gas-producing bacteria Actinotignum schaalii, Peptoniphilus asaccharolyticus, and Actinomyces odontolyticus. Meropenem was administered for 4 days postoperatively and then de-escalated to sulbactam/ampicillin for another 10 days. The patient was discharged on day 17 of hospitalization, and the postoperative course remained favorable. EPN is extremely rare in pediatric patients, and it is believed that nephrectomy is sometimes necessary if the patient does not have normal circulatory dynamics despite the use of catecholamines.
format	article
author	Hiroyuki Kitano Keisuke Hieda Hiroki Kitagawa Yusuke Nakaoka Yumiko Koba Kohei Ota Norifumi Shigemoto Tetsutaro Hayashi Seiya Kashiyama Jun Teishima Nobuaki Shime Hiroki Ohge Nobuyuki Hinata
author_facet	Hiroyuki Kitano Keisuke Hieda Hiroki Kitagawa Yusuke Nakaoka Yumiko Koba Kohei Ota Norifumi Shigemoto Tetsutaro Hayashi Seiya Kashiyama Jun Teishima Nobuaki Shime Hiroki Ohge Nobuyuki Hinata
author_sort	Hiroyuki Kitano
title	Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele
title_short	Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele
title_full	Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele
title_fullStr	Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele
title_full_unstemmed	Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele
title_sort	case report: emphysematous pyelonephritis with a congenital giant ureterocele
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/e0255ff7332d4699b7cbed49109c0228
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Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele

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