A 55-year-old man presented to the emergency department with a 5-day history of lower back pain and fevers. On admission, the white cell count was 24.7 x IOY'L, erythrocyte sedimentation rate (ESR) was 116mmh and a computed tomography (CT) scan revealed a right lower pole renal mass and a 4-cm infrarenal abdominal aortic aneurysm (AAA). Blood cultures were taken and the patient started on gentamicin and ceftriaxone.Two days after admission a right nephrectomy was performed. Frozen-section study could not distinguish between a neoplastic or infective mass. The renal mass was contiguous with the aneurysm which was not resected due to the high degree of technical difficulty and the possibility that the invasive mass was neoplastic.One day later the aortic aneurysm ruptured and the patient returned to the operating theatre after massive transfusion and cardiopulmonary resuscitation. Antibiotics were changed to ticarcillin clavulanate and gentamicin. Postoperatively the patient was haemodynamically stable for several days but died as a result of haemorrhage. Yersinia enterocolitica serogroup 3 biotype 4 was isolated from the original blood cultures and also from intra-operative aortic and renal specimens. The final kidney histology was consistent with tubulo-papillary renal cell carcinoma and the aortic wall showed severe atheroma and calcification but no carcinoma.
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