Immunosuppression Masking A Urological Emergency: A Case Report Of Bilateral Infected Obstructed Kidneys

Immunosuppression Masking A Urological Emergency: A Case Report Of Bilateral Infected Obstructed Kidneys

Philip O. Abolanle , Maike Eylert
Aneurin Bevan University Health Board, Newport, United Kingdom

Introduction: An infected obstructed kidney is a urological emergency with potential to cause life-threatening sepsis. It is commonly caused by a ureteric calculus and requires urgent intervention. We present a patient who presented with bilateral obstructed kidneys secondary to ureteric stones while on immunosuppressive therapy.

Case description: A middle-aged lady presented to the emergency department with sudden onset of upper abdominal pain, and fever of 400C. She was tachycardic and hypotensive on admission. She had bilateral lung transplants 9 months earlier and was maintained on Tacrolimus and prednisolone for immunosuppression. Clinical examination of the chest and abdomen revealed no obvious abnormalities, and blood tests showed barely abnormal laboratory values. A computed tomography scan of the abdomen and pelvis showed 6 mm right ureteric and 4 mm left vesico-ureteric calculi with no features of obstruction. Despite initial doubts as to whether the ureteric stones were the cause of the patient’s condition, it was decided to proceed with urological intervention in the absence of other pathology. The patient was expediently booked into emergency theatre and had multi-disciplinary team reviews. The patient had bilateral ureteric stents inserted and was admitted directly into the intensive care unit post-operatively where she made good recovery and was discharged safely. She had ureteroscopy and laser lithotripsy electively has been discharged from Urology follow-up.

Discussion: The case underscores the challenges in management of immunosuppressed patients, where atypical clinical presentations may cause diagnostic uncertainties. Multidisciplinary coordination is essential to achieve optimal outcomes in such complex scenarios.

Keywords: sepsis, immunosuppression, ureteric stones, urology