An unexpected focus of infection after kidney transplantation

A 36-year-old man with spina bifida aperta at the tenth vertebra level presented to the emergency department with fever and abdominal pain. The patient had undergone a kidney transplant 20 years earlier due to right renal agenesis and has an ileal conduit with urostomy, leaving the bladder in place with neurogenic voiding dysfunction. Despite years of recurrent complicated urosepsis, graft function remained excellent, with a creatinine level of 88.4 μmol/l (1.0 mg/dl). At presentation, he met criteria for acute graft pyelonephritis with fever, acute kidney injury, elevated inflammatory markers, leukocyturia, and bacteriuria.