Emphysematous pyelonephritis (EPN) is a rare life-threatening complication of a properly functioning renal allograft leading to potential graft loss and hemodialysis. Currently, no clear management guidelines exist in these clinically challenging immunosuppressed renal transplant recipients. We report a case of a 62-year-old woman who presented with class 4 EPN and was managed with intravenous antibiotics and nephrectomy at our medical center.
Diseases caused by invasive nontyphoidal Salmonella strains present with various extraintestinal manifestations, including bacteremia. Factors affecting the incidence include Salmonella serotype, geographic location, and host factors.
We present an unusual case of Salmonella enteritidis primary bacteremia in a patient without any risk factors and originating from a region with the lowest burden of invasive nontyphoidal Salmonella infections. We observed an incomplete clinical response to the treatment with a third-generation cephalosporin, despite the in vitro susceptibility of the strain.
The diagnosis of Salmonella bacteremia was far from expected in our previously healthy patient from Taiwan, without any preceding diarrhea and the lack of marked response to therapy with ceftriaxone. Making the diagnosis was a challenge, requiring wide range of laboratory, imaging, and consultative work to rule out alternative diagnoses and complications.
Invasive Salmonella infections are uncommon in our clinical practice at the present. Air transportation, intensive migration processes, and changes in climate are able to change the burden of infectious diseases dramatically in the near future. That fact along with the raising antibacterial resistance among invasive nontyphoidal Salmonella strains make imperative the profound understanding of the epidemiology and pathophysiology of those infections.