2022 Volume 55 Issue 5 Pages 335-340
A 79‒year‒old female, who had been on hemodialysis for 19 years and taking 5 mg/day prednisolone for rheumatoid arthritis for two years, presented with a complaint of lower abdominal pain. She had a fever and pyuria, and residual urine was revealed by plain abdominal computed tomography (CT). She was initially diagnosed with a urinary tract infection and received meropenem. Escherichia coli was detected in a urinary culture performed on admission, and Bacteroides thetaiotaomicron was detected in a blood culture. A second CT scan performed with contrast medium on the third hospital day revealed a peri‒vesical abscess. Percutaneous drainage was placed around the bladder on the fourth hospital day, and a urethral catheter was inserted. Clindamycin was added after Peptostreptococcus sp. were detected in the abscess culture. The patient’s symptoms improved； however, the abscess remained, and drainage was continued. She was transferred to another hospital to continue undergoing drainage. In this case, long‒term steroid use and chronic cystitis may have made the patient susceptible to bladder perforation. In addition, although the bacteria detected in the blood and urinary cultures differed, no anaerobic urinary culture was performed； therefore, it is important to perform appropriate cultures after considering the pathophysiology of each case.
