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Abstract：
Ureaplasma species, typically considered commensal organisms of the human urogenital tract, have been implicated in various urinary tract infections (UTIs), including the rare and challenging presentation of pyelonephritis. This case report describes a unique instance of pyelonephritis induced by Ureaplasma, characterized by a negative routine urine culture and a lack of response to empirical antibiotic treatment, highlighting the complexities associated with diagnosing and managing infections caused by atypical pathogens. A 50-year-old female presented to the emergency department with symptoms suggestive of UTI, including fever, vomiting, and dysuria. However, initial urine analysis was notable for pyuria while routine bacterial culture returned negative results, creating a diagnostic dilemma. Empirical treatment with third-generation cephalosporin was initiated. However, the patient\'s condition failed to improve, raising concerns about antibiotic resistance or atypical pathogens. Subsequent molecular diagnostics, precisely polymerase chain reaction (PCR), identified Ureaplasma urealyticum as the causative agent. This prompted a change in the treatment regimen to doxycycline, to which the patient showed significant clinical improvement. Physicians should be aware of Ureaplasma as a potential cause of pyelonephritis, especially in cases of culture-negative UTIs and when patients do not respond to standard empirical treatment. This case emphasizes the importance of considering atypical pathogens in differential diagnosis and the role of molecular diagnostic techniques in guiding appropriate management.
摘要：
脲原体物种，通常被认为是人类泌尿生殖道的共生生物，与各种尿路感染（UTI）有关，包括罕见且具有挑战性的肾盂肾炎。此病例报告描述了由脲原体引起的肾盂肾炎的独特实例，以常规尿培养阴性和对经验性抗生素治疗缺乏反应为特征，强调与诊断和管理非典型病原体引起的感染相关的复杂性。一名50岁的女性出现在急诊科，症状提示UTI，包括发烧,呕吐,还有排尿困难.然而,最初的尿液分析是明显的脓尿，而常规细菌培养返回阴性结果，制造诊断困境。开始使用第三代头孢菌素进行经验性治疗。然而,病人的情况没有改善，引起人们对抗生素耐药性或非典型病原体的担忧。随后的分子诊断，精确的聚合酶链反应（PCR），确定解脲支原体为病原体。这促使多西环素的治疗方案发生变化，患者表现出明显的临床改善。医生应该意识到脲原体是肾盂肾炎的潜在原因，尤其是在培养阴性尿路感染和患者对标准经验性治疗无反应的情况下。此病例强调了在鉴别诊断中考虑非典型病原体的重要性以及分子诊断技术在指导适当管理中的作用。
