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Extensive perinephric abscess complicated by herpes simplex virus 1 reactivation
  1. SA Alleyne1,
  2. SS Bukhari1,
  3. M Fraser1,
  4. P Spiers2
  1. 1Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK
  2. 2Department of Critical Care Medicine, University Hospitals of Leicester NHS Trust, General Hospital, Leicester, UK
  1. Correspondence to Sayed S Bukhari, Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK; Sayed.Bukhari{at}


A 43-year-old man, admitted with a swollen right thigh, was diagnosed with a deep vein thrombosis. On day 6 he became septic. A CT scan demonstrated a right-sided hydronephrosis and a large retroperitoneal collection. Blood cultures and perinephric pus grew Escherichia coli resistant to amoxicillin only. On day 12 a vesicular rash appeared on the neck and herpes simplex virus 1 (HSV-1) grew on culture. On day 15 an upper leg collection was seen on CT scan. Thigh tissue specimens grew extended-spectrum β-lactamase (ESBL) producing E coli and HSV-1 was also detected by polymerase chain reaction in the tissue. On day 18 the patient died. This case illustrates an unusual presentation and complication of a perinephric abscess. In critically ill patients herpes simplex reactivation and emergence of multiresistant organisms may occur resulting in treatment failure.

  • Renal
  • Escherichia coli
  • Herpes simplex virus-1
  • Diabetes

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.