Department of Emergency Medicine, University of South Alabama, USAUnited States
Also available as PDF (figures and tables appear in the PDF).
In this case report, we present a patient with severe pyelonephritis who presented complaining of passing worm-like tissue from his penis. This patient was passing macroscopic ureteral white blood cell casts resulting from a severe pyelonephritis caused by Klebsiella pneumoniae.
Keywords: Acute pyelonephritis; White blood cell casts; Urinary tract infections; Urinary tract infection (UTI); Ureteral casts
was that the material most likely represented a tubular cast formed in the patient’s ureter by abundant purulent material secondary to While renal corticomedullary abscess, perinephric abscess, his pyelonephritis. The patient was treated with piperacillin and emphysematous pyelonephritis, and papillary necrosis are tazobactam and made a full recovery. Neither the CT scan on recognized complications of pyelonephritis, the development admission nor a second CT scan several days later demonstrated of large, worm-like white cell casts is extremely rare. In fact, our any anatomical variations or abnormalities.
patient appears to be only the second case of white blood cell casts reported in the literature.
This case describes a macroscopic ureteral white blood cell cast resulting from a severe pyelonephritis. Urinary tract infections and pyelonephritis, a complicated urinary tract infection, are common maladies treated in the emergency department. A population-based study of acute pyelonephritis in the United States found overall annual pyelonephritis rates (out patient) of 10-13 cases per 10,000 females and 2-3 cases per 10,000 males.1 While it is common to find microscopic white blood cell casts in the urine of patients diagnosed with pyelonephritis, macroscopic white blood cell casts that form of the ureter in association with pyelonephritis appear to be extremely rare. This is the first report of a macroscopic ureteral white blood cell cast since 1901 when it was first described in the British Medical Journal.
The most frequent cause of acute complicated urinary tract infectionsis Escherichia coli. Other uropathogens causing pyelonephritis are Enterobacteriaceae (such as Klebsiella spp. and Proteus spp.), Pseudomonas, enterococci, and staphylococci
No consent was required for this deidentified case report and single case reports are exempt from institutional review board (IRB) review.