BACKGROUND Ureaplasma urealyticum is a fastidious bacteria which lacks a cell wall. Extragenital infections are rare in immunocompetent adults. There are few literature reports of perinephric abscess. We present a case of non-resolving multifocal "culture-negative" abscesses in a hypogammaglobulinemic adult female due to U. urealyticum. CASE PRESENTATION 66-year-old female with a one-week history of fever, malaise and new right hip and leg pain. Past medical history was notable for chronic pancytopenia secondary to in remission B cell follicular lymphoma, ESRD on intermittent hemodialysis with bilateral nephrostomy tubes and Crohn's. CT abdomen/pelvis revealed a small left perinephric hematoma and proximal right femur fluid collection. Persistent right thigh pain led to additional ultrasound with anterior thigh collection and CT revealed an irregular rim-enhancing fluid collection in the left posterior pararenal space. Antimicrobial therapy included ertapenem and vancomycin followed by meropenem, trimethoprim-sulfamethoxazole, daptomycin and metronidazole in setting of persistent culture-negative results and clinical deterioration. Following detection of U. urealyticum by 16S rDNA PCR in both left pararenal and right trochanteric bursa abscesses doxycycline was started. Despite this, the patient died four days later. CONCLUSIONS Disseminated infection by U. urealyticum has been documented in immunocompromised adult patients with few reports of perinephric abscess. We propose that ascending genitourinary route led to perinephric abscess. The multiple disseminated fluid collections make it highly suspicious for hematogenous spread given the lack of radiographic enhancement to suggest contiguous spread. Diagnosis and treatment of U. urealyticum-disseminated infection is extremely challenging as culture is laborious and not routinely performed. Furthermore, the lack of cell wall renders beta-lactams and vancomycin ineffective and therefore requirement for "atypical" coverage. Early diagnosis and treatment are key to prevent further complications and death.

中文翻译：

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解脲脲原体在免疫受损的成年患者中传播多灶性脓肿：一例病例报告。

背景技术解脲脲原体是缺乏细胞壁的挑食性细菌。具有免疫功能的成年人很少发生生殖器外感染。很少有文献报道会阴部脓肿。我们介绍了一种由于解脲支原体引起的低γ球蛋白成年女性多分辨“文化阴性”脓肿的病例。病例介绍66岁的女性，有一周的发烧，全身乏力和新出现的右臀部和腿部疼痛史。既往病史是继发于缓解性B细胞滤泡性淋巴瘤，伴有双侧肾造瘘管和克罗恩氏病的间歇性血液透析的ESRD后的慢性全血细胞减少症。CT腹部/骨盆显示有少量左肾周血肿和右股骨近端积液。持续的右大腿疼痛导致额外的超声检查，并收集了大腿前部，CT显示左肾后肾旁间隙中不规则的边缘增强液收集。抗菌治疗包括厄他培南和万古霉素，随后是美罗培南，甲氧苄氨嘧啶-磺胺甲基异恶唑，达托霉素和甲硝唑，以持续培养阴性结果和临床恶化。在左肾旁和右转子大滑囊脓肿中通过16S rDNA PCR检测到解脲脲原体后，开始使用强力霉素。尽管如此，患者在四天后死亡。结论在免疫功能低下的成年患者中已有解脲支原体的弥漫性感染的报道，很少有会阴脓肿的报道。我们建议上升的泌尿生殖道导致会阴性脓肿。由于缺乏影像学增强提示连续性散布，因此多个散布的液体集合使其高度怀疑血行散布。解脲脲原体传播感染的诊断和治疗极具挑战性，因为培养费力且不常规进行。此外，细胞壁的缺乏使得β-内酰胺和万古霉素无效，因此需要“非典型”的覆盖。早期诊断和治疗是预防进一步并发症和死亡的关键。细胞壁的缺乏使β-内酰胺和万古霉素无效，因此需要“非典型”的覆盖。早期诊断和治疗是预防进一步并发症和死亡的关键。细胞壁的缺乏使β-内酰胺和万古霉素无效，因此需要“非典型”的覆盖。早期诊断和治疗是预防进一步并发症和死亡的关键。