Ureaplasma urealyticum pyelonephritis associated with renal, perinephric, retroperitoneal, and bladder abscesses in a hypogammaglobinemic adult patient presenting with gross hematuria and marked thrombocytosis

Abstract

Ureaplasma urealyticum is an opportunistic bacterium that is often identified in asymptomatic, healthy individuals from colonization of the genitourinary tract. However, in immunocompromised patients with hypogammaglobulinemia, Ureaplasma has been reported to cause a wide range of infections, most commonly urethritis and cystitis. The absence of a bacterial cell wall prevents Ureaplasma from being cultured using routine bacteriologic media and makes it resistant to commonly prescribed antibiotics. As a result, delayed or missed diagnosis can occur with patients initially receiving inadequate medical management. The use of broad-range bacterial polymerase chain reaction (PCR) amplification to detect bacterial ribonucleic acid is often required to make the diagnosis in suspected cases. We present a rare case of Ureaplasma urealyticum causing histopathologically-confirmed unilateral pyelonephritis with associated renal, perinephric, retroperitoneal, and bladder abscesses in a hypogammaglobinemic adult patient. We performed a literature review for cases of Ureaplasma urealyticum causing upper urinary tract infections and nephric-perinephric abscesses and found that these are extremely rare manifestations.