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Alkaline-encrusted pyelitis and cystitis: an easily missed and life-threatening urinary infection

Siddhartha Lieten1, Dan Schelfaut, Karl Martin Wissing

  • 1Department of Nephrology & Hypertension, Universitair Ziekenhuis Brussel, Brussels, Belgium. siddharta.lieten@uzbrussel.be

BMJ Case Reports
|June 16, 2012
PubMed

Insights

Alkaline-encrusted pyelitis, a urinary infection caused by urea-splitting microbes, is often missed. Early diagnosis using sterile pyuria, alkaline urine, and CT scan findings is crucial to prevent fatal septic infections.

Area of Science:

  • Urology
  • Microbiology
  • Infectious Diseases

Background:

  • Alkaline-encrusted pyelitis is a rare urinary tract infection characterized by encrustations within the urinary tract wall.
  • It is primarily caused by slow-growing, urea-splitting microorganisms, notably Corynebacterium group D2.

Observation:

  • Diagnosis is frequently delayed due to the fastidious nature of the causative organisms.
  • Key diagnostic indicators include sterile pyuria, alkaline urine pH, and urinary tract calcifications visible on CT scans.
  • Confirmation requires prolonged culturing on specialized media.

Findings:

  • The study highlights a case where delayed diagnosis of alkaline-encrusted pyelitis led to recurrent septic urinary infections.
  • This ultimately resulted in patient mortality.

Implications:

  • Emphasizes the importance of considering alkaline-encrusted pyelitis in patients with unexplained sterile pyuria and urinary tract calcifications.
  • Underscores the need for prompt and accurate diagnosis to prevent severe complications and mortality associated with this infection.
  • Suggests the necessity of prolonged cultures for identifying fastidious microorganisms like Corynebacterium group D2.

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