PMC8662358_01
Radiological findings from an abdominal contrasted computed tomography scan. The damaged left kidney exhibits a poorly enhanced area and fluid and gas accumulation in the left retroperitoneal cavity (A,B). A giant ureterocele evident in the bladder (C).
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F1
Coma Scale score was 1, and Glasgow Coma Scale score was 14 (eye opening, 4; verbal response, 4; motor response, 6). Contrast-enhanced computed tomography revealed destructive left renal parenchyma replacement with a poor-contrasted area (Figure 1A) and fluid and gas accumulation from the perirenal region to the retroperitoneal cavity (Figure 1B). A giant ureterocele was observed in the left side of the bladder (Figure 1C).
Bacteria detected in urine and blood samples were cultured in a pre-reduced anaerobically sterilized medium. Bacteria detected after 24 h (A) and after 48 h (B). Clostridium perfringens was cultured for comparison of gas production. Actinotignum schaalii and Peptoniphilus asaccharolyticus produced gas in the KM media for 24 h (C), 48 h (D). Bacterial cultures from left to right are Actinotignum schaalii (1), Actinotignum schaalii (2), Peptoniphilus asaccharolyticus (3), Actinomyces odontolyticus (4), Prevotella bergensis (5), Actinotignum schaalii (6), Actinomyces turicensis (7), Prevotella disiens (8), Actinomyces odontolyticus (9), and Clostridium perfringens. Cultures 1-4 and 9 are from blood samples, with 1 and 2, and 4 and 9, cultured from independent blood samples. Cultures 5-8 are from urine samples.
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F2
A. odontolyticus in the blood culture as the inflammation-causing bacteria. All bacteria detected in urine and blood samples, along with Clostridium perfringens, which was used as the control for detecting gas production, were cultured using a pre-reduced anaerobically sterilized medium (Kyokuto Pharmaceutical Industrial), and the medium was observed after 24 and 48 h (Figures 2A,B). A. schaalii and P. asaccharolyticus were identified as the gas-producing bacteria in the blood culture (Figures 2C,D).