Asymptomatic bilateral obstructing ureteric calculi resulting in Lactobacillaemia and endocarditis requiring emergency aortic valve replacement

Abstract

Ureteric calculi are a common cause of emergency presentation to hospitals in the United Kingdom and worldwide. A significant and life threatening complication of those stones that obstruct the ureter is pyonephrosis, bacteraemia and resulting sepsis. Whilst the majority of such cases present with the typical symptoms of loin pain and fever, here we describe the case of a 57 year old patient with asymptomatic bilateral obstructing ureteric calculi that led to bacteraemia from a rare bacterial pathogen, Lactobacillus jensenii, and subsequent severe bacterial endocarditis requiring emergency aortic valve replacement.

Keywords: Aortic valve replacement; Endocarditis; Lactobacillus; Ureteric calculi.

Fig. 1

Coronal CT image demonstrating bilateral upper ureteric calculi (red arrows) with resulting hydronephrosis. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Transoesophageal echocardiogram images demonstrating large vegetations on the aortic valve cusps (A & B, red arrows) and torrential aortic regurgitation using the colour doppler setting (C). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)