Refractory <i>Salmonella</i> infection resulting in nephrectomy

Non-typhoidal <i>Salmonella</i> (NTS) infections, though commonly associated with gastroenteritis, can demonstrate focal non-gastrointestinal organ involvement. We present the case of a mid-30s woman who presented with long-standing left flank pain and was subsequently diagnosed with refractory <i>Salmonella</i> pyelonephritis in the setting of nephrolithiasis, severe hydronephrosis and parenchymal thinning suggestive of renal atrophy despite normal serum creatinine and a normal appearing contralateral kidney. Despite several guideline-based antibiotic courses, we failed to clear her multidrug-resistant <i>Salmonella</i> species bacteriuria. We then established percutaneous nephrostomy (PCN) drainage but still were unable to clear her infection, and it was noted PCN output dropped below 30 cc per day suggesting a non-functional renal unit.This patient was successfully managed with minimally invasive laparoscopic robotic-assisted left nephrectomy which finally cleared her bacteriuria. This case illustrates challenges in the management of refractory atypical <i>Salmonella</i> infections and highlights the rare indication of nephrectomy in such cases.