Recurrent Fever, Chills, Pyuria, and Bacteriuria in an Adult Male Following Urinary Catheterization

Abstract

This was the first University Hospital admission for this 55-year-old retired auto worker. He complained of recurrent episodes of chills, fever, pyuria, bacteriuria, low back pain, urgency and pressure on urination over the preceding year. The patient had a long history of severe, generalized atherosclerotic disease. Ten years prior to admission he underwent an aorto-iliac endarterectomy because of intermittent claudication. Four years prior to admission a carotid arteriogram was performed because of a “blackout” episode. The procedure was complicated by emboli to his legs with development of gangrenous extremities. He responded well to heparinization without the need for amputation. One year prior to admission a left femoral-popliteal bypass was performed. A foley catheter was inserted during the postoperative period. It was removed after three and a half hours. Two days later he developed fever, pain on urination, urgency and dribbling. His symptoms responded promptly to several courses of treatment with nitrofurantoin and cephalexin. The chills, fever and urinary symptoms returned, however, each time the antimicrobial agents were stopped. Repeated examination of the urine by microscopy and culture revealed pyuria and 100,000 E. coli per ml urine. Cystoscopy and manual palpation of the prostate did not reveal any abnormalities.