A Case Report on Perinephric Abscess Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

Abstract

Perinephric abscess is a rare life-threatening condition. It can complicate a urologic infection or occur secondary to hematogenous seeding. We report a case of a 49-year-old diabetic female who came to the outpatient department with complaints of right-sided abdominal pain for 2 days. It was associated with fever, headache, vomiting, and generalized weakness. Non-contrast computerized Tomography (NCCT) showed a subcapsular collection measuring 6.1× 5.7 × 4.4 cm noted adjacent to the lateral aspect of the right kidney. Following percutaneous nephrostomy, thick pus was drained from the abscess and sent for culture and sensitivity in the microbiology laboratory. Culture grew extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae which was sensitive to Carbapenems, Piperacillin Tazobactam, Fluoroquinolones, Netilmicin, Amikacin, and Tetracycline. The patient improved on treatment with the appropriate antibiotics. Perinephric abscesses should be considered as a differential diagnosis of fever with abdominal pain or flank pain since its non-specific nature can delay the diagnosis. Underlying diabetes mellitus (DM), urinary tract abnormalities, and immunodeficiency should be considered in a patient with a perinephric abscess. Ultrasonography (USG) and Computerized Tomography with contrast enhancement are crucial for diagnosis. The drainage of the abscess, either percutaneous or open, should be done. Klebsiella pneumoniae is a frequent cause of perinephric abscesses and mostly follows a complicated urinary tract infection. With high mortality rates, early diagnosis, and effective treatment of perirenal abscesses are required to improve the prognosis of patients.