SHM Converge Scientific Abstract ePoster Gallery-Is It Just E.COLI? A Rare Cause of Bilateral Pyelonephritis

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This case highlights that not all severe pyelonephritis is due to routine <strong>E. coli</strong> infection alone. A 32-year-old woman with recurrent UTIs presented with fever, hypotension, dysuria, edema, petechiae, flank pain, severe leukocytosis, anemia, thrombocytopenia, and acute kidney injury. Blood cultures grew <strong>E. coli</strong>, and CT imaging showed <strong>multifocal bilateral renal abscesses</strong> with a large left perinephric abscess extending into the psoas muscle.

Because of the unusually severe and recurrent course, a renal biopsy was performed. It showed <strong>malakoplakia</strong>, a rare chronic inflammatory condition characterized by macrophage dysfunction and the presence of <strong>Michaelis-Gutmann bodies</strong> on histology. Malakoplakia most commonly affects the urinary tract and is often associated with <strong>E. coli</strong> infection, especially in immunocompromised patients, though it can occur in others as well.

She was initially treated with <strong>minocycline, bethanechol, and ascorbic acid</strong>, but continued to have recurrent bacteremia due to inadequate source control. Ultimately, she required a <strong>radical left nephrectomy</strong> and long-term suppressive antibiotics. She remained stable at 6-month follow-up.

The key clinical lesson is that <strong>multiple bilateral renal abscesses, renal failure, and recurrent bacteremia should prompt evaluation for underlying processes such as malakoplakia</strong>, rather than assuming simple bacterial pyelonephritis. Diagnosis is histologic, and treatment may require prolonged antibiotics plus procedural or surgical source control when there is extensive disease.

Asset Subtitle

Niloofar Latifi

Meta Tag

Author List Niloofar Latifi

Category Clinical Vignettes

Concept Malacoplakia

Concept Michaelis-Gutmann Bodies

Concept Von Hansemann Cells

Concept Antibiotic Therapy

Concept Urinary Tract

Distinguished Non-Finalist

Presenter Organization Johns Hopkins Medicine

Presenting Author Niloofar Latifi

Track Adult

Keywords

pyelonephritis

E. coli

renal abscesses

perinephric abscess

malakoplakia

Michaelis-Gutmann bodies

recurrent bacteremia

acute kidney injury

radical nephrectomy

urinary tract infection

Malacoplakia

Michaelis-Gutmann Bodies

Von Hansemann Cells

Antibiotic Therapy

Urinary Tract