An Unusual Presentation of Pyelonephritis: Is it COVID-19 Related?

Abstract IntroductionIn severe cases of COVID-19, late complications such as coagulopathy and organ injury are increasingly described. In milder cases of the disease, the exact time frame and causal path of late onset complications has not yet been determined. Although direct and indirect renal injury by SARS-CoV-2 has been confirmed, hemorrhagic renal infection or coagulative problems in the urinary tract have not yet been described.Case PresentationThis case report describes a 35-year-old female without relevant medical history who, five days after having recovered from an infection with SARS-CoV-2, had an unusual course of acute pyelonephritis of the right kidney and persistent fever under targeted antibiotic treatment. A hemorrhagic ureteral obstruction and severe swollen renal parenchyma preceded the onset of fever and was related to the developing pyelonephritis. Sudden thrombotic vascular occlusion in the right eye appeared during admission. Symmetrical paresthesia in de limbs in combination of severe lower back pain and gastro-intestinal manifestation was documented and not been explained despite of intensive investigation.ConclusionWe present the unusual combination of culture confirmed bacterial hemorrhagic pyelonephritis with a blood clot in the proximal right ureter, complicated by a retinal venous thrombosis, in a patient who had recovered from SARS-CoV-2-infection five days before presentation. The case is suspect of a COVID-19 related etiology.