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Urology
Refractory Salmonella infection resulting in nephrectomy
  1. Dillon Jay Patel1,
  2. Evan Spencer2,
  3. Gerald Matthews2 and
  4. Sameh Naim3
  1. 1School of Medicine, New York Medical College, Valhalla, New York, USA
  2. 2WMCHealth, Valhalla, New York, USA
  3. 3Urology, NYC Health + Hospitals Metropolitan, New York, New York, USA
  1. Correspondence to Sameh Naim; sameh.naim16@gmail.com

Abstract

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.

  • Urinary tract infections
  • Renal intervention
  • Salmonella

https://doi.org/10.1136/bcr-2024-260911

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    Footnotes

    • X @EvanSpe72773131

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: DJP, ES, GM and SN. The following authors gave the final approval of the manuscript: DJP, ES, GM and SN. SN is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.