Dr Mehwish Asif1, Dr. Lucy McMullen1,2, Dr Franziska Pettit1, Prof Steven Krillis3
1Renal department st george hospital, Kogarah , Australia, 2UNSW st george clinical school, Kogarah , Australia , 3Infectious disease department st george hospital , Kogarah , Australia
Biography:
Bio to come.
Background:
Not all renal infections follow the script of ascending urinary tract disease. While pyelonephritis is a common diagnosis in febrile patients with flank pain, it is often assumed rather than proven. In diabetic patients, hematogenous spread particularly from hypervirulent organisms can present atypically. We present a rare case of Klebsiella pneumoniae sepsis complicated by a renal mycotic aneurysm, possibly the first reported renal artery aneurysm due to this organism.
Case Presentation:
A 55-year-old woman with poorly controlled diabetes presented with fever and left flank pain, but no urinary symptoms. Urine dipstick revealed positive nitrites (++) without pyuria, while microscopy showed significant pyuria (>100 x 10⁶/L white cells) with no organisms and a negative urine culture. Initial CT showed the non specific sign of perinephric stranding. Empiric antibiotics were commenced for presumed pyelonephritis. Blood cultures later identified hypermucoviscous Klebsiella pneumoniae, prompting escalation of care. Repeat imaging revealed a large perinephric hematoma, renal infarction, and gas within the kidney. Multiphase CT detected two small renal pseudoaneurysms with contrast extravasation, consistent with mycotic aneurysms. The patient underwent embolization and was subsequently admitted to the intensive care unit, where they received mechanical ventilation for pneumonia and prolonged intravenous ceftriaxone therapy. The patient recovered without the need for surgical intervention. No metastatic abscesses or endophthalmitis were found.
Conclusion:
This case highlights the importance of diagnostic flexibility in septic diabetic patients. Hypervirulent K. pneumoniae characterized by its thick capsule and propensity for hematogenous spread can cause severe vascular complications even without urinary tract involvement. Awareness of this organism and its rare but severe presentations, including mycotic aneurysm formation, is essential for timely diagnosis and management.