This is a 50-year-old non-diabetic and hypertensive patient with a history of renal failure secondary to chronic reflux pyelonephritis and a history of 4 renal transplants (1992, 2001, 2006 and 2010).
The last renal graft in the left iliac fossa (IIF) required vascular endoprosthesis and intraperitoneal placement.
Probable chronic graft nephropathy with 3 episodes of acute graft rejection with transplantectomy in 1999; 2) Early obstructive uropathy with transplantectomy a year later; 3)
She came to the emergency room for hemorrhagic shock due to rectal bleeding.
No fever or previous symptoms.
Hemodialysis was performed previously without incidents.
The physical examination revealed generalized pruritus, diaphoresis, malaise, poor general condition (AT: 82/56 mmHg, HR: 133 bpm, and SaO2 70%).
The abdomen showed mild mesogastric pain without signs of peritoneal irritation.
The rectal examination shows fresh blood.
Renal injection in non-painful IIF.
Her laboratory tests in the emergency department showed severe anemia with positive sepsis markers.
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CRP: C-reactive protein.
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She was admitted to the intensive care unit (ICU) with fluid replacement of 7 fluid concentrates.
Acquirement of antibiotic therapy, wide abdominal angio-CT and angiography without detecting foci of bleeding; presence of abundant gas inside the renal graft of IIF is observed, so antibiotic therapy is initiated.
After discharge from the ICU, the patient was transferred to the nephrology ward and a new catheter was implanted without detecting the source of bleeding.
Ultrasound confirmed the persistence of gas in the renal graft.
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Transplantectomy of the renal graft of the IIF was performed, as well as a destructured kidney with abscessification.
Pathology reports ischemic necrosis with thrombus in the renal artery.
Klebsiella pneumoniae and Klebsiella isolation was isolated in cultures.
The evolution is satisfactory after the intervention.
Days later, the patient developed a new episode of melena. Angio-CT showed an arteriovenous fistula in the distal area of the mesenteric artery, performing embolization with satisfactory results.
After two new episodes of rectal bleeding and anemia, the patient died.
We describe a case of PNE in a patient with non-functioning renal graft after the study of an episode of gastrointestinal bleeding. The CT describes the characteristic images of this disease.
Transplantectomy is performed as a treatment, in addition to broad-spectrum antibiotics. Histopathology shows lesions compatible with PNE.
Klebsiella pneumoniae and tapeworm were isolated from cultures of the pathological specimen, microorganisms isolated in cases reported in the literature.
The differential diagnosis should be made with: renal abscess, pyelonephritis x granulomatous and renal TB7.
Although our patient was not diabetic, a history of immunosuppression due to the history of multiple renal transplants may become an associated risk factor for developing PNE.
It is necessary to report these clinical cases to expand the epidemiology and clarify aspects of the pathogenesis that lead to optimal treatment in future cases6-9.
