Retroperitoneal abscess that ruptured the aorta： Invasive Klebsiella pneumoniae syndrome

An 80-year-old Japanese man was admitted to our hospital in April 2016 with an acute high-grade fever and back pain. A systemic contrast-enhanced computed tomography scan disclosed a retroperitoneal abscess around his aorta. The blood culture revealed Klebsiella pneumoniae. Antibiotics (Cefotaxime 1 g i.v. q 6 hours) were administered, but the patient's symptoms worsened. The abscess then ruptured the aorta. An emergency surgical repair was done, and the patient recovered. Invasive Klebsiella pneumoniae syndrome has been detected in southeast Asia over the past two decades, and here we describe a rare case of a retroperitoneal abscess caused by Klebsiella pneumoniae that ruptured the aorta

A Case with Significant Proteinuria Caused by Secreted Protein from Urothelial Carcinoma

58-year-old female was admitted to our hospital complaining isolated proteinuria of 1.7 g/day. Abdominal echography showed right-sided unilateral hydronephrosis, and computed tomography pointed out a tumor of the right renal pelvis, suggesting cancer of renal pelvis. The right nephroureterectomy was carried out. Pathological diagnosis was urothelial carcinoma. Renal tissue revealed no apparent glomerulopathy with tubular atrophy, interstitial fibrosis, and mildly-to-moderately interstitial mononuclear cell infiltration. Immunofluorescence study showed no deposition of immunoreactanct, and electron microscopy showed almost normal glomerulus without electron dense deposit. Proteinuria disappeared within 6 days after the operation. Moderate amount of proteinuria in our patient was probably caused by secreted protein from urothelial carcinoma. This condition is rare but should be taken into account in patients with even moderate amount of proteinuria