張東平、黃建榮、薛又仁、蕭毅君、賴昱維、邱文祥

台北市立聯合醫院仁愛院區外科部泌尿科；國立陽明大學醫學院泌尿學科

Tung-Ping Chang¹, Andy C. Huang¹, Thomas Y. Hsueh^1,2, Yi-Jiun Hsiao¹, Yu-Wei Lai^1,2, Allen W. Chiu^1,2

1. Department of Urology, Taipei City Hospital Ren Ai branch, Taipei, Taiwan

2. Department of Urology, National Yang-Ming University, Taipei, Taiwan

 

Salmonella epididymitis is rare and may be life-threatening in immunocompromised patients. Herein we reported a case of salmonellosis involving the genitourinary tract, including epididymis with refractory septic shock in a man with systemic lupus erythematosus(SLE).

A 55-year-old male with a history of systemic lupus erythematosus and seizure under prednisolone and valproate control presented to the emergency department with a 3-day history of painful and swollen left scrotum and fever. Abdominal computed tomography(CT) confirmed left ureteral stone with hydronephrosis and inflammatory process affecting the left epididymis without abscess formation. The patient received operation and urine drainage from bladder by Foley catheter after fever subsided. Urine culture isolated Salmonella spices which were susceptible to Cefepime, Imipenem, Meropenem and Trimethoprim/Sulfameth, so Meropenem was prescribed. Refractory septic shock and fever episodes has lasted for 2 weeks, so antibiotics was changed to Ertapenem and Gentamicin.The inotropic agents was gradully tapered off and the patient was discharged after completing an entire course of antibiotics.

Extra-intestinal Salmonella infections are rare clinical condition and epididymitis with refractory septic shock is intractable. Glucocorticoids in patients with systemic lupus erythematosus may be a risk factor. Treatment was empirically started and once the culture and sensitivity reports were available, antimicrobial therapy was modified accordingly. Parenteral therapy is recommended for at least 7 days followed by oral antibiotics for at least 4 weeks.