PMC6537462_01
(A) An elliptical cyst located in middle and low pole of the right kidney, which had low density with clear border and no enhancement, had been found. The size of the cyst was about 36 x 51x* 37 mm. And there was also an adrenal nodular hyperplasia with the diameter of 5 mm presented in the left adrenal. The left renal pelvis was compressed, and the left kidney was normal in size and position, with regular morphology and no abnormal density in renal parenchyma. Bilateral ureters showed no dilatation and abnormal density shadow. (B) At POD4, compared with the previous CT image, DJ tube could be seen in the right urinary tract, and high-density artifacts were seen in the right sinus. The shape of the right kidney was irregular and the density was not uniform. There were multiple wedge-shaped high-density shadows, and exudation and high-density shadows were seen around the right kidney and behind the peritoneum. The maximum cross section was about 104 x 72 mm. The middle and lower pole of the right kidney showed elliptical cystic low density, which was slightly smaller than the former, and the size was about 4.5x 2.6 cm. The size and shape of the left kidney can be seen. The left renal pelvis and ureter had no obvious dilatation or abnormal density shadow. (C) At POD 14, double-J tube could be seen. Drainage tube shadows were seen in the right retroperitoneal space. High-density artifacts can be seen in the right sinus. The morphology of the right kidney was irregular and the density of parenchyma was uneven. The cystic density in front of the right iliac psoas was obviously lower compared with before. A small amount of fluid in the abdomen and pelvis was presented. (D) At POD 27, high-density artifacts can be seen in the right sinus. The morphology of the right kidney was irregular and the density of parenchyma became more uniform. The size of the irregular cystic shadow in the anterior part of right iliopsoas muscle was smaller, and the density was lower than before. A smaller amount of effusion was seen in the abdominal cavity. And no clear effusion was found in the pelvic cavity.
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And there was also an adrenal nodular hyperplasia presented in the left adrenal (Figure 1A). Renal artery embolization was performed successfully under local anesthesia, and renal artery branch hemorrhage was found during the operation (Figure 1B). Four times of CT results before and after the invasive operations are shown in Figure 1. The symptoms and CT results gradually improved (Figure 1C). It was kept the same until the inflammatory markers regained their normal levels and CT results showed this treatment was effective (Figure 1D).
Blood neutrophile granulocyte count (NEUT 108/L), C-reaction protein (CRP mg/L) and body temperatures from before-operation-day (BOD) 1 to POD 37.
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However, since the cyst incision operation, the inflammatory markers were high, which included body temperature, blood neutrophile granulocyte count (NEUT) and C-reaction protein, suggesting an infection statue of the patient (Figure 2).
The timeline of this case with the times of invasive operation, symptoms and the prescripts of anti-infective agents.
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The timeline of the invasive operations, symptoms and anti-infective medicine prescriptions is shown in Figure 3.
The coverage profile and phylogenetic tree of the M. hominis strain X.
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However, some pin-point colonies were detected on the Columbia blood agar (CBA) plate and chocolate agar (Figure 4). The closest strain to strain X was CP009652.1 M. hominis ATCC 27545 and CP011538.1 M. hominis strain sprout (Figure 4).
The pin-point colonies grew on CBA plate.
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The result showed a M. hominis infection (Table 1, Figure 5), which was reported to the attending doctor at POD 17.