SHM Converge Scientific Abstract ePoster Gallery-When Broad Beta-Lactams Are Not the Answer: Renal Abscesses Due to Ureaplasma Urealyticum in a B-Cell Depleted Woman With Systemic Lupus Erythematosus

When Broad Beta-Lactams Are Not the Answer: Renal Abscesses Due to Ureaplasma Urealyticum in a B-Cell Depleted Woman With Systemic Lupus Erythematosus

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This case report describes a 20-year-old woman with systemic lupus erythematosus, lupus nephritis, and immune suppression from obinutuzumab, mycophenolate, hydroxychloroquine, and prednisone who developed recurrent urinary symptoms, sterile pyuria, and ultimately extensive bilateral renal abscesses. Despite broad-spectrum antibiotics including meropenem and vancomycin, she continued to have high fevers, tachycardia, and enlarging abscesses, while routine cultures remained negative.<br /><br />Because of persistent culture-negative infection in an immunocompromised patient, clinicians suspected Ureaplasma. After empiric doxycycline was started, her fever curve and inflammatory markers improved. PCR from urine and drained abscess fluid later confirmed Ureaplasma urealyticum. Due to slow recovery and concern about resistance, therapy was changed to levofloxacin plus azithromycin. Her fevers resolved and the renal abscesses gradually shrank on imaging, with near-complete resolution by follow-up MRI.<br /><br />The report emphasizes that Ureaplasma species are cell wall–deficient organisms, so they are intrinsically resistant to beta-lactam and glycopeptide antibiotics. Invasive Ureaplasma infections are uncommon in adults but are increasingly recognized in patients with profound immunosuppression, especially after anti-CD20 therapy. These infections are often missed because cultures are slow or negative; PCR is more sensitive and faster.<br /><br />The key clinical lessons are:<br />1. In immunocompromised patients with persistent sterile pyuria or unexplained renal abscesses, clinicians should consider PCR testing for Ureaplasma or Mycoplasma.<br />2. Broad beta-lactams may fail; doxycycline is first-line, and fluoroquinolones or macrolides may be needed.<br /><br />The authors conclude this may be the first reported case of multifocal renal abscesses caused by U. urealyticum in the setting of obinutuzumab treatment for SLE/ITP.

Asset Subtitle

Milla J. Kviatkovsky

Meta Tag

Author List Ahmed Elshazly, Alexis Elliott, Anne Cowell, Hanzhen Zhang, Matthew Moldenhauer, Milla J. Kviatkovsky

Category Clinical Vignettes

Concept Ureaplasma urealyticum

Concept Renal Abscess

Concept Pyelonephritis

Concept Immunocompromised State

Concept B-cell Depletion

Distinguished Non-Finalist

Presenter Organization UC San Diego

Presenting Author Milla J. Kviatkovsky

Track Adult

Keywords

systemic lupus erythematosus

lupus nephritis

obinutuzumab

Ureaplasma urealyticum

renal abscesses

sterile pyuria

immunosuppression

PCR diagnosis

doxycycline

culture-negative infection

Ureaplasma urealyticum

Renal Abscess

Pyelonephritis

Immunocompromised State

B-cell Depletion