Pyelonephritis and Bacteremia From Lactobacillus acidophilus

Abstract

Lactobacillus species have been uncommonly reported to cause clinically significant infections in both immunocompetent and immunocompromised hosts. Lactobacillus bacteremia of renal origin remains a rare clinical entity. We describe a case of pyelonephritis and bacteremia from Lactobacillus acidophilus. To our knowledge, this is only the fourth reported case of pyelonephritis caused by Lactobacillus. We report the case of a 63 year old African American female who had a history of right sided nephrolithiasis and hydronephrosis with recent right ureteral stent placement. She was admitted with pyelonephritis and the ureteral stent was subsequently removed. A new right ureteral mass was discovered at the time of stent removal and biopsy revealed high grade urothelial carcinoma. Blood and urine cultures grew Lactobacillus acidophilus. Antibiotic therapy was directed according to susceptibility pattern. Lactobacillus should be considered as a pathogen when it is isolated (in the appropriate clinical setting) from at least two blood cultures or in one blood culture along with another source especially when the host has one or more predisposing conditions. Lactobacillus species are associated with unusual antimicrobial susceptibility patterns. Lactobacillus should be a suspected pathogen in patients with bacteremia due to gram-positive rods whose condition does not improve with vancomycin therapy.

J Med Cases. 2012;3(4):223-225

doi: https://doi.org/10.4021/jmc638e