Macroscopic White Blood Cell Casts: An Extremely Rare Presentation of Klebsiella Pyelonephritis
White blood cell casts are extremely rare and only one previous report was found
in our non-systematic review of the literature.
A 33-year-old previously healthy man presented to the emergency department with
a one-week history of painful urination, body aches, fatigue, nausea, vomiting, and chills.
On the morning of presentation, he reported passing worm-like “tissue” that “shot out” of his
penis following an intense urge to urinate. At presentation, he was afebrile, and his vital signs
were within normal limits.
The specimen was sent for culture and pathologic examination. Laboratory testing
demonstrated a leukocytosis of 20,600 white blood cells/mm.
The abdominal CT scan documented a severe left pyelonephritis with early intrarenal
abscess formation and a suspected ureteral cast protruding into the bladder.
The patient’s urine culture grew Gram-negative lactose-fermenting bacilli, and one
of two blood cultures was positive for Klebsiella pneumoniae.
The final pathology assessment was that the material most likely represented a tubular cast formed
in the patient’s ureter by abundant purulent material secondary to
his pyelonephritis.
This case describes a macroscopic ureteral white blood cell cast resulting from a severe pyelonephritis.
Urinary tract infections and pyelonephritis, a complicated urinary tract infection, are common
maladies treated in the emergency department.
While it is common to find microscopic white blood cell casts in the urine of patients
diagnosed with pyelonephritis, macroscopic white blood cell casts that form of the ureter
in association with pyelonephritis appear to be extremely rare.
Emerg Med Open J. 2020; 6(1): 9-10. doi: 10.17140/EMOJ-6-157
