Refractory Salmonella infection resulting in nephrectomy

Non-typhoidal Salmonella (NTS) infections, though commonly associated with gastroenteritis, can demonstrate focal non-gastrointestinal organ involvement. We present the case of a mid-30s woman who presented with long-standing left flank pain and was subsequently diagnosed with refractory Salmonella pyelonephritis in the setting of nephrolithiasis, severe hydronephrosis and parenchymal thinning suggestive of renal atrophy despite normal serum creatinine and a normal appearing contralateral kidney. Despite several guideline-based antibiotic courses, we failed to clear her multidrug-resistant Salmonella species bacteriuria. We then established percutaneous nephrostomy (PCN) drainage but still were unable to clear her infection, and it was noted PCN output dropped below 30 cc per day suggesting a non-functional renal unit.This patient was successfully managed with minimally invasive laparoscopic robotic-assisted left nephrectomy which finally cleared her bacteriuria. This case illustrates challenges in the management of refractory atypical Salmonella infections and highlights the rare indication of nephrectomy in such cases.