An unusual case of dramatic acute bilateral pyelonephritis with systemic bacterial dissemination caused by uropathogenic Escherichia coli.

Pyelonephritis is the most severe form of urinary tract infection (UTI) and occurs more frequently in women than in men [1]. Escherichia coli is the pathogen most often involved and causes >80% of communityacquired UTIs as well as 50% of UTIs in hospital patients [2]. Although antibiotic treatment is effective in most cases, recurrent kidney infection may lead to chronic pyelonephritis in some patients. Here, we report a case of acute bilateral pyelonephritis due to an E.coli isolate which, despite antibiotic therapy, led to systemic bacterial dissemination and very rapid destruction of both kidneys. This infection was associated with prolonged septic shock that unavoidably led to bilateral nephrectomy. Host defences and pathogen virulence were studied.