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Urinoma presenting as an abscess in an immunocompromised host: a case report.

Vaidya R, Swetz KM - J Med Case Rep (2013)

Bottom Line: Here we report a case of a retroperitoneal fluid collection found in an immunocompromised 65-year-old Caucasian woman.She had recurrent non-Hodgkin's lymphoma and was neutropenic when the collection was found.Clinicians caring for immunocompromised patients, particularly hematologists, oncologists, and transplant clinicians, should be aware of this potential complication because rapid identification and attempt at correction are important to optimize outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. swetz.keith@mayo.edu.

ABSTRACT

Introduction: This case report illustrates the relatively rare occurrence of a urinoma masquerading as an abscess in a patient with refractory recurrent non-Hodgkin's lymphoma. Although urinomas have been reported after urinary instrumentation, our case was confounded by a concurrent pleural effusion, an immunocompromised host, and clinical appearance and subsequent incision and drainage that was consistent with an abscess. Although not the first case reported in the literature, the constellation of findings in our patient demonstrates the importance of including urinoma in the differential diagnosis of patients with flank mass.

Case presentation: Here we report a case of a retroperitoneal fluid collection found in an immunocompromised 65-year-old Caucasian woman. She had recurrent non-Hodgkin's lymphoma and was neutropenic when the collection was found. Drainage of the fluid demonstrated infection, but the case was complicated by increasing fluid production and the development of an ipsilateral pleural effusion. Despite pleural drainage, the abscess output continued to be high. A computed tomography scan demonstrated fluid collection around the renal calices suggestive of rupture; analysis of the fluid was suggestive of a urinoma. The etiology, pathogenesis, and treatment of urinomas in such patients are discussed.

Conclusions: Urinomas can present in patients who have had urinary tract instrumentation or trauma, but can occur in other hosts. Patients with hematologic malignancy can develop malignant or sympathetic pleural effusions and are at risk for skin and soft tissue infections. Clinicians caring for immunocompromised patients, particularly hematologists, oncologists, and transplant clinicians, should be aware of this potential complication because rapid identification and attempt at correction are important to optimize outcome.

No MeSH data available.


Related in: MedlinePlus

Timeline of clinical events.
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Figure 1: Timeline of clinical events.

Mentions: During the course of her radiation to the lymphomatous mass (timeline noted in Figure 1), the patient noted a 4×3cm tender fluctuant mass on her left mid-back outside the field of radiation. Laboratory tests showed an absolute neutrophil count of 0.9×109/L, which was consistent with myelosuppression from her most recent systemic chemotherapy. The patient was afebrile and hemodynamically stable, but given her immunocompromised state, immediate surgical consultation was obtained and drainage was recommended. An incision immediately yielded approximately 50mL of turbid fluid, but a drain was unable to be placed at that time. Given the concern of a subcutaneous abscess infected with Staphylococcus, Streptococcus, and anaerobic organisms, amoxicillin and clavulanic acid was started initially. A Gram stain demonstrated Gram-negative rods and treatment was continued; however, cultures grew quinolone-sensitive, beta-lactam resistant Enterobacter cloacae, and the patient was treated with oral ciprofloxacin for 14 days.


Urinoma presenting as an abscess in an immunocompromised host: a case report.

Vaidya R, Swetz KM - J Med Case Rep (2013)

Timeline of clinical events.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750268&req=5

Figure 1: Timeline of clinical events.
Mentions: During the course of her radiation to the lymphomatous mass (timeline noted in Figure 1), the patient noted a 4×3cm tender fluctuant mass on her left mid-back outside the field of radiation. Laboratory tests showed an absolute neutrophil count of 0.9×109/L, which was consistent with myelosuppression from her most recent systemic chemotherapy. The patient was afebrile and hemodynamically stable, but given her immunocompromised state, immediate surgical consultation was obtained and drainage was recommended. An incision immediately yielded approximately 50mL of turbid fluid, but a drain was unable to be placed at that time. Given the concern of a subcutaneous abscess infected with Staphylococcus, Streptococcus, and anaerobic organisms, amoxicillin and clavulanic acid was started initially. A Gram stain demonstrated Gram-negative rods and treatment was continued; however, cultures grew quinolone-sensitive, beta-lactam resistant Enterobacter cloacae, and the patient was treated with oral ciprofloxacin for 14 days.

Bottom Line: Here we report a case of a retroperitoneal fluid collection found in an immunocompromised 65-year-old Caucasian woman.She had recurrent non-Hodgkin's lymphoma and was neutropenic when the collection was found.Clinicians caring for immunocompromised patients, particularly hematologists, oncologists, and transplant clinicians, should be aware of this potential complication because rapid identification and attempt at correction are important to optimize outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. swetz.keith@mayo.edu.

ABSTRACT

Introduction: This case report illustrates the relatively rare occurrence of a urinoma masquerading as an abscess in a patient with refractory recurrent non-Hodgkin's lymphoma. Although urinomas have been reported after urinary instrumentation, our case was confounded by a concurrent pleural effusion, an immunocompromised host, and clinical appearance and subsequent incision and drainage that was consistent with an abscess. Although not the first case reported in the literature, the constellation of findings in our patient demonstrates the importance of including urinoma in the differential diagnosis of patients with flank mass.

Case presentation: Here we report a case of a retroperitoneal fluid collection found in an immunocompromised 65-year-old Caucasian woman. She had recurrent non-Hodgkin's lymphoma and was neutropenic when the collection was found. Drainage of the fluid demonstrated infection, but the case was complicated by increasing fluid production and the development of an ipsilateral pleural effusion. Despite pleural drainage, the abscess output continued to be high. A computed tomography scan demonstrated fluid collection around the renal calices suggestive of rupture; analysis of the fluid was suggestive of a urinoma. The etiology, pathogenesis, and treatment of urinomas in such patients are discussed.

Conclusions: Urinomas can present in patients who have had urinary tract instrumentation or trauma, but can occur in other hosts. Patients with hematologic malignancy can develop malignant or sympathetic pleural effusions and are at risk for skin and soft tissue infections. Clinicians caring for immunocompromised patients, particularly hematologists, oncologists, and transplant clinicians, should be aware of this potential complication because rapid identification and attempt at correction are important to optimize outcome.

No MeSH data available.


Related in: MedlinePlus