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Pyocystis

Published:September 21, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.08.032
      A 79-year-old man presented with an 11-day history of fever, which persisted even after treatment with levofloxacin. The patient also complained of abdominal distention. Although the patient had had anuria and no urge to urinate for over a year, “urine” was voided when the patient fell down 1 day prior to the onset of fever. The patient had a history of end-stage renal disease due to diabetic nephropathy, which required hemodialysis for 5 years. Physical examination revealed lower abdominal tenderness without signs of peritoneal irritation. No prostate tenderness upon rectal examination or costovertebral angle knocking pain was noted. Blood tests showed elevated white blood cell count and C-reactive protein levels of 10,750/µL and 26.5 mg/dL, respectively. Computed tomography revealed a distended bladder that reached navel height, with a relatively thickened wall (Figure, panel A). More than 600 mL of purulent urinary discharge was obtained through a urethral catheter (Figure, panel B), and white blood cells 10 to 19/high power field in the urine sediment were observed. Culture of the discharge had no growth. Pyocystis was the final diagnosis, and his fever disappeared after adding bladder irrigations.
      Figure
      FigurePyocistis. (A) The distended bladder with relatively thickened wall on computed tomography. (B) Purulent urinary discharge.
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