Immunosuppression Masking a Urological Emergency: A Case Report of Bilateral Infected Obstructed Kidneys

An infected obstructed kidney is a urological emergency with the potential to cause life-threatening sepsis. It is often due to ureteric calculi and requires urgent decompression by ureteric stent or percutaneous nephrostomy. We present a patient who presented with bilateral obstructed kidneys secondary to ureteric stones while on immunosuppressive therapy. A middle‑aged woman with prior bilateral lung transplants on tacrolimus and prednisolone presented with acute abdominal pain, fever, tachycardia, and hypotension. Clinical examination was unremarkable, and blood tests showed normal inflammatory markers and renal function. CT imaging revealed a 6 mm right distal ureteric calculus and a 4 mm left vesicoureteric junction calculus with subtle obstructive features. Despite atypical findings, urological intervention was pursued, given ongoing sepsis and absence of alternative pathology. The patient underwent bilateral ureteric stenting and was admitted to intensive care, recovered well, and was discharged. Elective ureteroscopy and laser lithotripsy achieved stone clearance six weeks later, with no recurrence at six‑month follow‑up. She has been discharged from urology follow-up. The case underscores the challenges in diagnosis and management of immunosuppressed patients, where atypical clinical presentations may cause diagnostic uncertainties. Multidisciplinary coordination is essential to achieve optimal outcomes in such complex scenarios.