Pyocystis in an anuric patient undergoing chronic haemodialysis

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A 67‐year‐old anuric man, who had a history of liver transplantation for cirrhosis caused by hepatitis C 5 years ago and was undergoing chronic haemodialysis for end‐stage kidney disease as a result of diabetic nephropathy for the past 3 years, was admitted with appetite loss and odynophagia. He received treatment for cytomegalovirus enteritis and candidal oesophagitis for 9 days. During the course of treatment, he developed fatigue, low grade fever, and thrombocytopaenia; however, there were no abnormal signs or symptoms on physical examination suggestive of urinary tract infection. We obtained blood cultures and enhanced computed tomography images to identify the source of infection. It revealed a prominent thickening and increased density of the bladder wall (Fig. 1). Thereafter, we obtained a urine culture using urethral catheterization. The urine was cream coloured and purulent, and a large number of Gram‐negative rod‐shaped bacteria were observed on Gram staining. Thus, we initiated IV ceftazidime. Klebsiella pneumoniae was detected in the urine and blood cultures, and pyocystis was diagnosed. We subsequently continued the administration of antibiotics for 4 weeks and collected urine using urethral catheterization daily. At the end of the treatment, the clinical status improved.
Pyocystis, known to cause serious urinary tract infections, occurs in anuric patients, such as those undergoing chronic haemodialysis.1 It is imperative not to overlook the possibility that the urinary tract is the source of infection in anuric patients.
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