SHM Converge Scientific Abstract ePoster Gallery-"Leave No Stone Unturned"

Pdf Summary

This case report describes a 70-year-old man with multiple comorbidities, including lymphoma status post chemotherapy, COPD, chronic kidney disease, diabetes, and hypertension, who presented with weakness, diarrhea, chills, headache, and vague abdominal pain. Initial evaluation showed mild leukocytosis, acute kidney injury, chronic anemia, and a urinalysis with leukocytes but negative nitrites, making the urinary source less obvious.<br /><br />Despite the atypical presentation, the patient became more tachycardic and borderline hypotensive, prompting treatment with broad-spectrum antibiotics. Urine culture and one blood culture bottle grew Proteus mirabilis. Given his abdominal pain, immunocompromised state, and bacteremia, a CT scan of the abdomen and pelvis was obtained and revealed an obstructing right kidney stone with bilateral hydronephrosis. He underwent urgent cystoscopy and ureteral stent placement, during which significant purulent drainage was released, confirming an infected obstructing stone. After surgery, he clarified that his pain had radiated to his back, consistent with renal colic.<br /><br />The discussion emphasizes that Proteus mirabilis is a urease-producing organism strongly associated with struvite stones and staghorn calculi. These stones can become chronically infected and serve as a nidus for bacteremia and sepsis. The report highlights that nitrite testing is specific but poorly sensitive for urinary tract infection, so a negative nitrite result should not reassure clinicians when suspicion remains high.<br /><br />The key lesson is that older or immunocompromised patients with vague abdominal symptoms, leukocytosis, AKI, or Proteus infection should have a low threshold for imaging to evaluate for obstructive urolithiasis. Early recognition and urgent intervention are essential to prevent severe outcomes such as sepsis or death.

Asset Subtitle

Caroline Soane

Meta Tag

Author List Caroline Soane, Chase Jeffrey J. Webber DO FACP, Derek Pae MD, Gautam Babu MD

Category Clinical Vignettes

Concept Proteus mirabilis

Concept Urinary Tract Infection

Concept Obstructed infected urinary stone

Concept Struvite calculus

Concept Obstructive Urolithiasis

Distinguished Non-Finalist

Presenter Organization Vanderbilt University School of Medicine

Presenting Author Caroline Soane

Track Adult

Keywords

Proteus mirabilis

obstructing kidney stone

hydronephrosis

bacteremia

urosepsis

struvite stones

urinary tract infection

urease-producing bacteria

acute kidney injury

cystoscopy

Proteus mirabilis

Urinary Tract Infection

Obstructed infected urinary stone

Struvite calculus

Obstructive Urolithiasis