Letters to the Editor
Perinephric Abscess Caused by Group B Streptococcus
FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.
FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.
Am Fam Physician. 2004 Jun 15;69(12):2764-2766.
to the editor: A 37-year-old black woman with poorly controlled type 1 diabetes and a history of urinary tract infections (UTIs) presented with a three-week history of increasing sharp right flank pain, tactile fever, chills, nausea, anorexia, and a single episode of hematuria. She denied dysuria, frequency, urgency, vomiting, or abdominal pain. Four days earlier, she had been placed on trimethoprim-sulfamethoxazole for a UTI at another hospital. Her past surgeries included tubal ligation, three cesarean sections, and removal of an ectopic pregnancy. Her medical history included hypertension, iron deficiency anemia, depression, and hypercholesterolemia.
Six weeks before admission, she was treated with ciprofloxacin for a UTI by her personal physician; however, urine culture ultimately grew group B streptococcus (GBS) not sensitive to ciprofloxacin. Initial follow-up with her physician indicated she was improving.
Physical examination revealed a slender, uncomfortable woman. Her pulse was 114 and blood pressure was 142/91 mm Hg. She exhibited pale mucosa and a soft cardiac flow murmur, a benign abdominal examination, but significant right flank tenderness. Pelvic examination and wet preparation revealed yeast and trichomonal vaginitis. A bilateral distal peripheral neuropathy was present.
White blood cell count was 10,000 per mm3 (10 × 109 per L), with a differential of 73 percent neutrophils, 10 percent lymphocytes, and 16 percent monocytes; hemoglobin level, 8.6 g per dL (86 g per L); and platelet count, 272 × 103 per mm3 (240 × 109 per L). Urinalysis revealed glucosuria, mild proteinuria, excretion of six to 10 red blood cells and one to five white blood cells per high-powered field, with negative leukocyte esterase and nitrate. Chemistry panel was normal except for a glucose level of 317 mg per dL (17.6 mmol per L). Hemoglobin A1c was 16.3 percent.
A computed tomography scan revealed a 4- to 6-cm right perinephric abscess and non-specific enlargement of both kidneys. This patient recovered with percutaneous drainage of the abscess and intravenous antibiotics directed against GBS, which grew from the abscess drainage.
GBS is a cause of fatal puerperal sepsis. In addition to colonization of the pregnant female genital tract with the risk of early or late onset of neonatal sepsis, GBS causes approximately 2 percent of cystitis, pyelonephritis, and nongonococcal urethritis in adults. Other invasive GBS infections include pneumonia, endocarditis, arthritis, osteomyelitis, skin and soft tissue infections, and, rarely, unusual abscesses and device-related infections.1 These illnesses are more common in blacks and elderly persons.
One report2 describes a 17-year-old black girl with poorly controlled diabetes mellitus and duplication of her upper right ureter–who exhibited signs and symptoms similar to our patient. There also have been case reports of GBS perinephric abscess in a 47-year-old woman,3 a young adult man with diabetes,4 a male newborn,5 and a 61-year-old woman with diabetes who was treated for renal abscess caused by “ß-hemolytic streptococcus.”6
GBS may cause perinephric abscess and other types of invasive infections, particularly in persons with underlying medical problems. It is important that this organism be treated with antibiotics active against GBS when found to be the etiologic agent of UTI.
1. Edwards MS, Baker CJ. Streptococcus agalactiae (Group B Streptococcus). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and practice of infectious diseases. 5th ed. Philadelphia: Churchill Livingston, 2000:2156–67.
2. Woods CR, Edwards MS. Renal abscess caused by group B Streptococcus. Clin Infect Dis. 1994;18:662–3.
3. Ishizu K, Yamaguchi S, Naito K. A case of multiloculated retroperitoneal abscess successfully treated by percutaneous drainage with a Malecot catheter [in Japanese]. Hinyokika Kiyo. 1999;45:103–5.
4. Jernelius H, Tollig H. Renal abscess caused by Streptococcus group B [in Swedish]. Lakartidningen. 1982;79:3832.
5. Walker KM, Coyer WF. Suprarenal abscess due to group B streptococcus. J Pediatr. 1979;94:970–1.
6. Morse FP 3d, Bennett AH. Unusual renal infections. Urology. 1973;2:405–8.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions