Abstract Introduction Salmonella spp. is a pathogen rarely implicated in urinary tract infections (UTIs), with a reported incidence of between 0.01% and 0.07% of UTI cases. Most cases are preceded by Salmonella enteritis with a maximum reported interval of 4 months. We describe a unique case of Salmonella UTI in the setting of severe urinary tract structural anomaly with a remote history of Salmonella enteritis. Case Presentation A 91-year-old man with the past medical history of hemorrhagic cystitis, benign prostatic hyperplasia (BPH), and recurrent UTIs, presented with a 24-hour history of gross hematuria. On presentation, the patient was hypotensive and tachycardic, with leukocytosis and elevated lactate. Initial urinary analysis was suggestive of an acute UTI with a positive nitrite, large leukocyte esterase, 100 WBC/HPF, and many bacteria. Blood and urine cultures were collected. Upon chart review, the patient was culture positive for a Salmonella UTI approximately 1 month prior and tested positive for Salmonella species in a fecal matter culture 22 months prior during a hospitalization for severe diarrhea. A CT chest/abdomen/pelvis obtained one month prior to presentation identified diffuse bladder wall thickening and multiple bladder diverticuli, likely related to chronic urinary retention from BPH. The patient was started on continuous bladder irrigation (CBI), and empiric antibiotic therapy with intravenous ceftriaxone and linezolid. He transiently required vasopressor support with norepinephrine and vasopressin. Cystoscopy was performed with clot evacuation. Mild prostatic regrowth with inflammation and hemorrhage, a severely trabeculated bladder with decompensated appearance, and multiple diverticuli, with turbid and grossly purulent urine were noted. Prostatic growth was resected with biopsy, which demonstrated acute and chronic inflammatory change. Post-procedure, the patient continued CBI. 2/2 of original urine cultures collected grew 100,000 CFU/ml of Salmonella species, confirming a diagnosis of prostatitis in the setting of a Salmonella UTI. Treatment with intravenous ceftriaxone was continued, in addition to levofloxacin for prostatitis. The patient clinically improved and discharged home with plans for prolonged course of oral levofloxacin. Discussion While structural anomalies of the urinary tract are a known risk factor for Salmonella UTI, this case expands on this with demonstration of a link to severe bladder wall trabeculations, which has not been reported previously. Previously, the longest reported interval between Salmonella enteritis and Salmonella UTI was 4 months. This case significantly expands this interval to 22 months. Clinicians should have ongoing vigilance for late recurrence of Salmonella in the presence of severe urologic structural compromise. This abstract is funded by: None
Wilson et al. (Fri,) studied this question.