A case of pyelonephritis and bacteremia from lactobacillus species in a pregnant woman with type 2 diabetes mellitus

Abstract

A 41-year-old woman was admitted to our hospital because of back pain and a fever. Her laboratory data showed an elevated C-reactive protein level (22.99 mg/dL) and white blood cell count (17630/μL) as well as bacteriuria. Abdominal computed tomography revealed enlargement of the renal pelvis potentially caused by blockage with a ureteral stone, so she was diagnosed with right pyelonephritis. She was found to have uncontrolled diabetes (plasma glucose 249 mg/dL, HbAlc 10.6 % and ketonuria) and be pregnant. Lactobacillus spp. was isolated from the urine and blood cultures. After admission, antibiotics and drip infusion were started intravenously, along with continuous intravenous insulin infusion therapy. A stent for ureter stenosis were performed. The patient was discharged from the hospital 22 days later. Lactobacilli are part of the normal gastrointestinal and female genitourinary flora in humans and rarely but occasionally cause disease. An immunocompromised status due to hyperglycemia and gestational genitourinary flora changes might have contributed to the pathogenesis of this case.