Multiple Embolic Strokes in Kidney Transplant Recipient Due to Kidney Allograft Abscesses after Urinary Tract Infection (UTI)

Introduction: Intrarenal and perinephric abscess formations are infrequent infectious complications in kidney allograft recipients. There have been reported cases of abscesses within the allograft but no reported cases of ischemic embolic strokes from such abscesses Case Description: 63 year old male post deceased donor kidney transplant presented with altered mental status, fever and leukocytosis. He tested positive for COVID-19 at an outside hospital 2 days prior. Because of febrile illness blood cultures and urine cultures were drawn which both resulted positive for Enterococcus faecalis. He was initially emperically treated for bacterial/viral meningitis but therapy was de-escalated after results from a lumbar puncture were negative and urine and blood cultures were positive for E. Faecalis. After 5 days of appropriate antibiotic therapy he was afebrile with improving leukocytosis however continued to have altered mentation, hence, a brain MRI was done which showed multiple bilateral ischemic strokes in anterior left pons, medial right occipital lobe and medial temporal lobes bilaterally likely embolic in nature. A transesophageal echocardiogram did not show any vegetations. A kidney allograft ultrasound was done which showed a 3.0x1.3x3.1 cm complex fluid collection within the right lower quadrant of kidney midpole, the findings were suspicious for abscess. He then underwent a CT Abdomen and pelvis which showed multiple rim-emhancing fluid collections measuring up to 3.6 cm concerning for pyelonephritis with renal abscess. Due to lack of a tranplant surgeon at our facility he was then transferred out to his transplant center for drainage of the abscess Discussion: A renal allograft abscess is a relatively rare condition. Embolic CVA from bacterial emboli of renal abscess source has not been reported so far to the best of our kowledge. Appropriate antimicrobial therapy and drainage are recommended for treating renal abscesses