Vol. 42 (5): 1033-1036, September – October, 2016
CHALLENGING CLINICAL CASES
Alessandro Capitanini 1, Luca Rosso 1, Laura Giannecchini 2, Ophelia Meniconi 3, Adamasco Cupisti 3
1 Nephrology Unit, Ospedale di Pescia, Pescia, Italia; 2 Intensive Care Unit, Ospedale di Pescia, Pescia, Italia;
3 Department of Clinical and Experimental Medicine, Università di Pisa, Pisa, Italia
A 47-year old, Caucasian man underwent extracorporeal shock wave lithotripsy (ESWL) of a 14mm calcium stone in the right renal pelvis, without urinary tract obstruction or sepsis. 24 hours after ESWL septic shock occurred and the patient was admitted to the Intensive Care Unit (ICU). Escherichia coli emerged from the blood and urine culture. The patient developed acute renal failure and it was necessary to start a continuous renal replacement therapy (CRRT). Infection was successfully treated, patient recovered renal function and an improvement of general condition occurred. The patient was then discharged but three day later the patient returned to the hospital to seek treatment for left facial hemiparesis and hypotonia of his left arm. The brain computed tomography showed a wide abscesso (55x75mm) in the frontal right parietal region. A neurosurgical intervention was then performed and the culture of the drained material resulted positive for Escherichia coli. The guidelines of European and American Associations of Urology do not suggest a prophylactic antibiotic therapy for pre-ESWL (except in the presence of risk factors). The serious complication that occurred in the described low risk patient raises the question of whether routine culture and/or antibiotic prophylaxis, is appropriate.
Keywords: Lithotripsy; Urolithiasis; Shock, Sepsis; ESWL