Abstract
In severe cases of COVID-19, late complications such as coagulopathy and organ injury are increasingly described. In milder cases of the disease, the exact time frame and causal path of late-onset complications have not yet been determined. Although direct and indirect renal injury by SARS-CoV-2 has been confirmed, hemorrhagic renal infection or coagulative problems in the urinary tract have not yet been described. This case report describes a 35-year-old female without relevant medical history who, five days after having recovered from infection with SARS-CoV-2, had an unusual course of acute pyelonephritis of the right kidney and persistent fever under targeted antibiotic treatment. A hemorrhagic ureteral obstruction and severe swollen renal parenchyma preceded the onset of fever and was related to the developing pyelonephritis. Sudden thrombotic venous occlusion in the right eye appeared during admission. Symmetrical paresthesia in the limbs in combination with severe lower back pain and gastro-intestinal complaints also occurred and remained unexplained despite thorough investigation. We present the unusual combination of culture-confirmed bacterial hemorrhagic pyelonephritis with a blood clot in the proximal right ureter, complicated by retinal vein thrombosis, in a patient who had recovered from SARS-CoV-2-infection five days before presentation. The case is suspect of a COVID-19-related etiology.
Highlights
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), recognized as a pandemic by the WHO in March 2020, has presented increasing challenges for healthcare professionals and societies
We present a case of a 35-year-old female without comorbidity, who, five days after recovering from COVID-19, had an unusual course of acute bacterial pyelonephritis, hemorrhagic ureteral obstruction, and persistent fever despite antibiotic treatment
We describe the case of a young female, who, five days after recovering from COVID-19, had an unusual course of acute bacterial pyelonephritis combined with hemorrhagic ureteral obstruction and a thrombotic venous occlusion of the right retinal vein
Summary
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), recognized as a pandemic by the WHO in March 2020, has presented increasing challenges for healthcare professionals and societies. Acute kidney injury is a common characteristic of hospitalized patients with severe COVID-19 infection [1, 3]. Such renal injury through systemic illness, sepsis, vascular occlusion, and even direct viral damage of the nephron are increasingly documented, pyelonephritis and ureteral complications have not yet been reported in relation to a SARS-CoV-2 infection [3,4,5]. We present a case of a 35-year-old female without comorbidity, who, five days after recovering from COVID-19, had an unusual course of acute bacterial pyelonephritis, hemorrhagic ureteral obstruction, and persistent fever despite antibiotic treatment
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