Fulminant course of unilateral emphysematous pyelonephritis revealing a renal actinomycosis caused by Actinomyces meyeri, an unknown cause of septic shock

Abstract

The objective of this case report is to describe the first case of renal actinomycosis caused by Actinomyces meyeri presenting as severe emphysematous pyelonephritis and complicated by septic shock and multi-organ failure. Emphysematous pyelonephritis is a potentially life-threatening infection mostly described in diabetic patients and predominantly caused by uropathogenic bacteria. Actinomycosis is an uncommon chronic infection due to anaerobic gram-positive bacteria that unusually involves the urinary tract. We report the first case of emphysematous pyelonephritis caused by A. meyeri in a 75-year-old non-diabetic woman. The patient presented with an altered status, fever, nausea, and vomiting lasting for 2 days. A computed tomography scan revealed unilateral emphysematous pyelonephritis. She was rapidly admitted to intensive care unit for a septic shock with multiple organ dysfunctions. A conservative management consisting in renal percutaneous drainage, supportive measures, and prolonged adapted antibiotic therapy resulted in complete recovery. This case report illustrates that renal actinomycosis should be considered in case of emphysematous pyelonephritis given the good prognosis of this infection with conservative medical treatment.

Indications for Percutaneous Drainage in Patients with Huang Class 3B Emphysematous Pyelonephritis: A Case Report and Literature Review

“…PCD was performed in 19.4% of the patients. Twelve Class 3B patients underwent PCD (Table 4) (3)(4)(5)(6)(7)(8)(12)(13)(14)(15)(16)(17). Extensive renal parenchymal destruction was defined as the destruction of the renal parenchyma from the upper pole to the lower pole.…”

Thoracic and Renal Actinomycosis Requiring Complete Right Nephrectomy in a Costa Rican Female Child

“…It is important to know that renal Actinomyces is rare and it is difficult to recognize the infection. It should be considered in the etiological diagnosis for emphysematous and xanthogranulomatous pyelonephritis [8].…”

Actinomyces meyeri: A Rare Cause of Postsurgical Pelvic Actinomycosis

“…The oropharynx is currently thought to be the normal niche of A. meyeri [ 6 ]. Most commonly, A. meyeri is associated with pulmonary infections thought to be secondary to aspiration [ 3 , 7 ]. One unusual feature of pneumonia caused by A. meyeri is systemic dissemination, most frequently to skin, long bones, liver, brain, and muscles [ 3 ].…”