Extensive perinephric abscess complicated by herpes simplex virus 1 reactivation.
A 43-year-old man, admitted with a swollen right thigh, was diagnosed with a deep vein thrombosis. On day 6 he became septic. A CT scan demonstrated a right-sided hydronephrosis and a large retroperitoneal collection. Blood cultures and perinephric pus grew Escherichia coli resistant to amoxicillin only. On day 12 a vesicular rash appeared on the neck and herpes simplex virus 1 (HSV-1) grew on culture. On day 15 an upper leg collection was seen on CT scan. Thigh tissue specimens grew extended-spectrum beta-lactamase (ESBL) producing E coli and HSV-1 was also detected by polymerase chain reaction in the tissue. On day 18 the patient died. This case illustrates an unusual presentation and complication of a perinephric abscess. In critically ill patients herpes simplex reactivation and emergence of multiresistant organisms may occur resulting in treatment failure.
Alleyne
S A
SA
Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
Bukhari
S S
SS
Fraser
M
M
Spiers
P
P
D000038:Abscess / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D000328:Adult; D004927:Escherichia coli Infections / Q000150:complications*; D017809:Fatal Outcome; D006561:Herpes Simplex / Q000150:complications*; D018259:Herpesvirus 1, Human / Q000502:physiology*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D008297:Male; D014057:Tomography, X-Ray Computed; D014775:Virus Activation