罕見病例報告：輸尿管狹窄患者因羅氏菌引起之化膿性腎盂腎炎

王惟弘¹、唐靖²

¹國泰綜合醫院 外科部 泌尿科；²汐止國泰綜合醫院 外科部 泌尿科

A rare cause of pyonephrosis: ureteral stenosis with hematogenous rothia infection

Wei-Hung Wang¹, Chin Tang²

¹Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

²Division of Urology, Department of Surgery, Sijhih Cathay General Hospital, New Taipei, Taiwan

Abstract

We present a case of a 60-year-old overweight woman with a history of endometriosis who had a hysterectomy about 30 years ago. She presented to our emergency department with left flank pain, turbid urine, and chills for two days. Lab data showed an elevated C-reactive protein (CRP) level, and urine analysis revealed severe hematuria and pyuria. An abdominal and pelvic computer tomography (CT) scan showed a left distal ureteral stenosis with localized calcification as well as severe hydroureteronephrosis. Broad-spectrum antibiotics were initiated, and subsequently, a left ureterorenoscopy was performed. During the operation, a constricted, fibrotic stenotic band at the left lower ureter with severe upstream pyonephrosis was noted. Laser endoureterotomy was then performed, followed by the placement of a double-J stent. The patient's symptoms improved dramatically the day after the operation. Her urine culture later came out as Rothia species. Upon further questioning, she recalled that she had a dental cavity a few days before admission, which was left untreated.

        Rothia species are Gram-positive cocco-bacilli that can either be aerobic or facultatively anaerobic. They are nonmotile and do not form spores, but can produce filamentous branches. These bacteria are typically associated with dental issues but can also cause various illnesses such as bacteremia, pneumonia, and bone infections. Invasive disease is rare in healthy individuals but can occur in those with conditions such as hematological malignancy, severe neutropenia, as well as diabetes and HIV infection. To the best of our knowledge, urinary tract infection with Rothia species has rarely been reported in the literature. We present this case to highlight the potential role of Rothia species in invading the urinary tract system, possibly through a hematogenous route, in healthy individuals. It emphasizes the importance of clinical awareness of uncommon pathogens causing urinary tract infections and pyelonephritis in patients with dental issues.