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Emphysematous pyelonephritis and cystitis in a renal transplant recipient
  1. Mohammed Mahdi Althaf1,
  2. Mohamed Said Abdelsalam1,2,
  3. Mohamed Rashwan1,
  4. Quaid Nadri1
  1. 1Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Ar-Riyadh, Saudi Arabia
  2. 2Internal Medicine Department, Renal Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
  1. Correspondence to Dr Mohammed Mahdi Althaf, moalthaf{at}, malthaf{at}

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A 71-year-old man underwent living non-related renal transplantation 5 months prior to presentation. His family brought him to the emergency room with an altered level of consciousness, high-grade fever, vomiting and lower abdominal pain over a period of 8 days. The cause of end-stage renal disease was unknown and he had been on continuous ambulatory peritoneal dialysis prior to the transplantation. His medical history was significant for hypertension, chronic obstructive pulmonary disease and coronary artery disease. He did not have a history of diabetes mellitus nor did he develop post-transplant diabetes mellitus. Immunosuppressive regimen included mycofenolate mofetil, tacrolimus and prednisone but antibody induction therapy was not employed. He underwent transurethral resection of the prostate 2 months earlier for symptomatic benign prostatic hypertrophy. A surveillance urine culture within 2 weeks of the procedure was negative. He was on prophylactic trimethoprim-sulfamethoxazole and had monthly follow-up appointments in the post-transplant clinic where screening urine cultures are performed every …

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