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Yersinia pseudotuberculosis aortitis in a patient with diverticulosis and polycystic kidney disease.

McCloskey S, Haslam P, Price DA, Sayer JA - Oxf Med Case Reports (2015)

Bottom Line: An 81-year-old gentleman with chronic kidney disease presented with pyrexia and a new systolic cardiac murmur.Abdominal imaging also revealed progressive bilateral polycystic kidney disease with associated diverticular disease, which was postulated as the source of the Y. pseudotuberculosis.An autosomal dominant polycystic kidney disease may present late in life and extra-renal manifestations of this disease are an important cause of morbidity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Renal Unit , Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK.

ABSTRACT
An 81-year-old gentleman with chronic kidney disease presented with pyrexia and a new systolic cardiac murmur. Investigations revealed infective aortitis of a pre-existing aortic aneurysm graft repair. Peripheral blood cultures were positive for Yersinia pseudotuberculosis and the patient was successfully treated with an extended course of antibiotics. Abdominal imaging also revealed progressive bilateral polycystic kidney disease with associated diverticular disease, which was postulated as the source of the Y. pseudotuberculosis. An autosomal dominant polycystic kidney disease may present late in life and extra-renal manifestations of this disease are an important cause of morbidity.

No MeSH data available.


Related in: MedlinePlus

Abdominal CT scan. (A) Cystic change bilaterally within kidneys suggestive of ADPKD. Cystic kidneys are marked with asterisks. (B) Soft tissue mass (arrowed) anterior to the aortic graft suggestive of graft aortitis.
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OMV032F1: Abdominal CT scan. (A) Cystic change bilaterally within kidneys suggestive of ADPKD. Cystic kidneys are marked with asterisks. (B) Soft tissue mass (arrowed) anterior to the aortic graft suggestive of graft aortitis.

Mentions: On admission, he was pale, breathless on minimal exertion and lethargic. Initial blood tests revealed a haemoglobin of 7.4 g/dl, raised inflammatory markers (CRP peaking at 47 mg/l) and acute kidney injury (stage 1) with a serum creatinine of 169 µmol/l and a serum bicarbonate of 24 µmol/l (compared with a pre-admission baseline of 113 µmol/l). A chest X-ray was normal. Peripheral blood cultures grew Yersinia pseudotuberculosis after 24 h. The source of the sepsis was investigated using transthoracic and transoesophageal echocardiography, but these showed no evidence of cardiac valvular vegetations. A dual-phase bone scan and radiolabelled white cell scan showed no cause for symptoms, and a CT scan of the abdomen excluded any occult collections but revealed that the patient had bilaterally polycystic kidneys and several small liver cysts, consistent with a clinical diagnosis of ADPKD (Fig. 1A). A comparison with imaging performed prior to his AAA repair showed an increase in total kidney volume (measured using an ellipsoid equation) over the course of these 8 years, with right renal volume increasing from 954 to 1900 m and left renal volume increasing from 499 to 1360 ml. He was treated with intravenous Tazocin (pipericillin and tazobactam) for 7 days and then switched to oral amoxicillin. The patient completed 14 days treatment and was discharged home 41 days after his admission but represented after 14 days with on-going fever and further deterioration. Blood cultures taken on re-admission again grew Y. pseudotuberculosis, and the patient was commenced on doxycycline and ciprofloxacin. Repeat CT abdomen imaging showed evidence of mild graft aortitis and extensive sigmoid diverticulosis, which was postulated as the source of the infective organism (Fig. 1B). Further immunological screens and screens for infections for blood-borne viruses were negative. He was treated with a 6-month course of oral ciprofloxacin and doxycycline antibiotics and made a full recovery. His renal function improved to a new baseline serum creatinine of 150 µmol/l (eGFR 40 ml/min/1.73 m2).Figure 1:


Yersinia pseudotuberculosis aortitis in a patient with diverticulosis and polycystic kidney disease.

McCloskey S, Haslam P, Price DA, Sayer JA - Oxf Med Case Reports (2015)

Abdominal CT scan. (A) Cystic change bilaterally within kidneys suggestive of ADPKD. Cystic kidneys are marked with asterisks. (B) Soft tissue mass (arrowed) anterior to the aortic graft suggestive of graft aortitis.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664852&req=5

OMV032F1: Abdominal CT scan. (A) Cystic change bilaterally within kidneys suggestive of ADPKD. Cystic kidneys are marked with asterisks. (B) Soft tissue mass (arrowed) anterior to the aortic graft suggestive of graft aortitis.
Mentions: On admission, he was pale, breathless on minimal exertion and lethargic. Initial blood tests revealed a haemoglobin of 7.4 g/dl, raised inflammatory markers (CRP peaking at 47 mg/l) and acute kidney injury (stage 1) with a serum creatinine of 169 µmol/l and a serum bicarbonate of 24 µmol/l (compared with a pre-admission baseline of 113 µmol/l). A chest X-ray was normal. Peripheral blood cultures grew Yersinia pseudotuberculosis after 24 h. The source of the sepsis was investigated using transthoracic and transoesophageal echocardiography, but these showed no evidence of cardiac valvular vegetations. A dual-phase bone scan and radiolabelled white cell scan showed no cause for symptoms, and a CT scan of the abdomen excluded any occult collections but revealed that the patient had bilaterally polycystic kidneys and several small liver cysts, consistent with a clinical diagnosis of ADPKD (Fig. 1A). A comparison with imaging performed prior to his AAA repair showed an increase in total kidney volume (measured using an ellipsoid equation) over the course of these 8 years, with right renal volume increasing from 954 to 1900 m and left renal volume increasing from 499 to 1360 ml. He was treated with intravenous Tazocin (pipericillin and tazobactam) for 7 days and then switched to oral amoxicillin. The patient completed 14 days treatment and was discharged home 41 days after his admission but represented after 14 days with on-going fever and further deterioration. Blood cultures taken on re-admission again grew Y. pseudotuberculosis, and the patient was commenced on doxycycline and ciprofloxacin. Repeat CT abdomen imaging showed evidence of mild graft aortitis and extensive sigmoid diverticulosis, which was postulated as the source of the infective organism (Fig. 1B). Further immunological screens and screens for infections for blood-borne viruses were negative. He was treated with a 6-month course of oral ciprofloxacin and doxycycline antibiotics and made a full recovery. His renal function improved to a new baseline serum creatinine of 150 µmol/l (eGFR 40 ml/min/1.73 m2).Figure 1:

Bottom Line: An 81-year-old gentleman with chronic kidney disease presented with pyrexia and a new systolic cardiac murmur.Abdominal imaging also revealed progressive bilateral polycystic kidney disease with associated diverticular disease, which was postulated as the source of the Y. pseudotuberculosis.An autosomal dominant polycystic kidney disease may present late in life and extra-renal manifestations of this disease are an important cause of morbidity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Renal Unit , Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK.

ABSTRACT
An 81-year-old gentleman with chronic kidney disease presented with pyrexia and a new systolic cardiac murmur. Investigations revealed infective aortitis of a pre-existing aortic aneurysm graft repair. Peripheral blood cultures were positive for Yersinia pseudotuberculosis and the patient was successfully treated with an extended course of antibiotics. Abdominal imaging also revealed progressive bilateral polycystic kidney disease with associated diverticular disease, which was postulated as the source of the Y. pseudotuberculosis. An autosomal dominant polycystic kidney disease may present late in life and extra-renal manifestations of this disease are an important cause of morbidity.

No MeSH data available.


Related in: MedlinePlus