[Encrusted pyelitis in patients with urinary diversion]

Area of Science:

• Urology
• Infectious Diseases
• Nephrology

Background:

• Encrusted pyelitis (EP) is a severe kidney infection.
• Urinary diversions, like the Bricker type, can predispose patients to urinary tract infections.
• Corynebacterium urealyticum (CU) is a challenging pathogen in urinary tract infections.

Observation:

• A patient with a history of cystectomy and Bricker urinary diversion developed EP.
• Clinical presentation included deteriorated renal function, anuria, hematuria, fever, and flank pain.
• Helical CT revealed calcification plaques in the renal pelvis, and CU culture confirmed the diagnosis.

Findings:

• Early treatment with vancomycin and oral acidification with acetohydroxamic acid led to negative urine cultures and reduced pyelic calcifications.
• The patient's renal function improved significantly after treatment.

Implications:

• EP should be considered in patients with urinary diversion, regardless of recent urological procedures.
• Prompt recognition of risk factors and timely, effective treatment can improve prognosis.
• This case highlights the importance of considering unusual pathogens in complex urinary tract infections.