Acute Pyelonephritis Complicated by Renal Vein Thrombosis and Pulmonary Embolism in Patient without any Thrombotic Risks

Kwangsoo Lee; Areum Kim; Seung Youn Lee; Ju Hong Jung; Mijeong Kim; Jin-Soo Lee; Moon-Hyun Cheong; Kee-chun Hong; Soon-Koo Cho

doi:10.3947/ic.2009.41.5.293

Journal List > Infect Chemother > v.41(5) > 1075481

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Kim, Lee, Jung, Kim, Lee, Cheong, Hong, and Cho: Acute Pyelonephritis Complicated by Renal Vein Thrombosis and Pulmonary Embolism in Patient without any Thrombotic Risks

Case Report

Infection and Chemotherapy

Infection and Chemotherapy 2009; 41(5): 293-297.

Published online: 31 October 2009

DOI: https://doi.org/10.3947/ic.2009.41.5.293

Acute Pyelonephritis Complicated by Renal Vein Thrombosis and Pulmonary Embolism in Patient without any Thrombotic Risks

Kwangsoo Lee, M.D.¹, Areum Kim, M.D.¹, Seung Youn Lee, M.D.¹, Ju Hong Jung, M.D.¹, Mijeong Kim, M.D., Ph.D.¹, Jin-Soo Lee, M.D., Ph.D.¹, Moon-Hyun Cheong, M.D., Ph.D.¹, Kee-chun Hong, M.D., Ph.D.², Soon-Koo Cho, M.D., Ph.D.³

¹Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.

²Department of General Surgery, Inha University School of Medicine, Incheon, Korea.

³Department of Radiology, Inha University School of Medicine, Incheon, Korea.

Corresponding author: Mijeong Kim, M.D., Ph.D. Department of Internal Medicine, Inha University School of Medicine, 7-206, 3-ga, Sinheung-dong, Jung-gu, Incheon, 400-711, Korea. Tel: +82-32-890-2202, Fax: +82-32-882-6578, retitia@daum.net

Received 3 June 2009 Accepted 12 August 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Renal vein thrombosis (RVT) is not an uncommon condition amongst patients with nephrotic syndrome or malignancy. Septic pulmonary embolism (SPE) is associated with risk factors such as intravenous drug use, pelvic thrombophlebitis, and suppurative processes in the head and neck. However, acute pyelonephritis is a rare cause of RVT and SPE. Case reports on RVT and SPE due to acute pyelonephritis are rare. In most of the earlier cases, patients had underlying conditions such as diabetes mellitus, renal carcinoma, calyceal stones, and hyperhomocysteinemia. We report a case of acute pyelonephritis complicated by RVT and SPE that occurred in a patient without any predisposing risk factors for thromboembolism. RVT and SPE were diagnosed using computed tomography and ventilation/perfusion scan. The patient recovered with antibiotics and anticoagulation therapy without any surgical interventions.

Keywords: Pyelonephritis, Pulmonary embolism, Venous throbosis, Renal vein

Figures and Tables

Figure 1

Chest x-ray shows small amount of pleural effusion and multiple nodular lesions in both lung fields (A). Abdominal CT shows low attenuated lesion in upper pole of right kidney (B lower arrow) and thrombosis in right renal vein (B upper arrow).

Figure 2

Ventilation-perfusion scan of the lung shows multiple nonsegmental perfusion defects.

References

1. Rossi SE, Goodman PC, Franquet T. Nonthrombotic pulmonary emboli. AJR Am J Roentgenol. 2000. 174:1499–1508.

2. Griffith GL, Maull KI, Sachatello CR. Septic pulmonary embolization. Surg Gynecol Obstet. 1977. 144:105–108.

3. MacMillan JC, Milstein SH, Samson PC. Clinical spectrum of septic pulmonary embolism and infarction. J Thorac Cardiovasc Surg. 1978. 75:670–679.

4. O'Donnell AE, Selig J, Aravamuthan M, Richardson MS. Pulmonary complications associated with illicit drug use: an update. Chest. 1995. 108:460–463.

5. Cook RJ, Ashton RW, Aughenbaugh GL, Ryu JH. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest. 2005. 128:162–166.

6. MacMillan JC, Milstein SH, Samson PC. Clinical spectrum of septic pulmonary embolism and infarction. J Thorac Cardiovasc Surg. 1978. 75:670–679.

7. Eijsten A, Leisinger HJ, Jucker A. Unilateral pyonephrosis with septic thrombosis of the renal vein and vena cava. Urol Int. 1986. 41:77–79.

8. Mamzer-Bruneel MF, Anglicheau D, Correas JM, Skhiri H, Jacobs F, Chrétien Y, Legendre C, Kreis H. Renal venous thrombosis: a forgotten complication of acute pyelonephritis. Presse Med. 1997. 26:1334–1336.

9. Choi MJ, Kim TH, Lee JD, Cho YB, Lee HS, Jeon JS, Min HJ, Lee JG, Song CS. A case of acute pye lonephritis complicated with renal vein thrombosis. Korean J Med. 2000. 59:339–342.

10. Kumar S, Singh SK, Mavuduru RS, Acharya NC, Agarwal MM, Jha VK, Mandal AK. Acute pyelonephritis with renal vein and inferior vena cava thrombosis in a case of hyperhomocysteinemia. Int Urol Nephrol. 2009. 41:185–188.

11. Lee SJ, Cha SI, Kim CH, Park JY, Jung TH, Jeon KN, Kim GW. Septic pulmonary embolism in Korea: Microbiology, clinicoradiologic features, and treatment outcome. J Infect. 2007. 54:230–234.

12. Günalp M, Gürler S, Polat O, Demirkan A. Septic pulmonary embolism associated with renal abscess: a case report. J Emerg Med. Forthcoming 2009.

13. Lee HY, Kim NH, Kim JH, Kim DH, Kim YS, Jee YK, Park JS. A case of septic pulmonary embolism due to pyelonephritis. Korean J Med. 2009. 76:105–109.

14. Zenda T, Araki I, Hiraiwa Y, Miyayama S, Masunaga T, Takeda Y, Ueno T, Takeda R. Septic pulmonary emboli secondary to pyogenic liver abscess in a diabetic patient. Intern Med. 1995. 34:42–45.

15. Tsai AW, Cushman M, Rosamond WD, Heckbert SR, Polak JF, Folsom AR. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med. 2002. 162:1182–1189.

16. Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation. 2008. 117:93–102.

17. Sakuma M, Sugimura K, Nakamura M, Takahashi T, Kitamukai O, Yazu T, Yamada N, Ota M, Kobayashi T, Nakano T, Shirato K. Unusual pulmonary embolism: septic pulmonary embolism and amniotic fluid embolism. Circ J. 2007. 71:772–775.

18. Lederman ER, Crum NF. Pyogenic liver abscess with a focus of Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol. 2005. 100:322–331.

19. Golpe R, Marín B, Alonso M. Lemierre's syndrome (necrobacillosis). Postgrad Med J. 1999. 75:141–144.

TOOLS

Similar articles