CASE REPORT Perinephric abscess caused by Streptococcus agalactiae after renal transplantation Guilherme Santoro-Lopes a, * , Ma ´rcia Halpern a , Renato Torres Gonc ¸alves b a Department of Preventive Medicine, Infectious Diseases Clinic, Hospital Universita ´ rio Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil b Renal Transplant Unit, Hospital Universita ´ rio Clementino Fraga Filho,Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Accepted 19 November 2004 KEYWORDS Streptococcus agalactiae; Kidney transplantation; Diabetes mellitus; Abscess Abstract We describe the case of a 37 year-old diabetic woman who presented with a multiloculated perinephric abscess caused by Streptococcus agalactiae 12 months after receiving a living-related kidney graft. Infection was successfully treated with surgical drainage and a four-week course of antibiotic therapy. To our knowledge, this is the first report of a perinephric abscess caused by this agent in a renal transplant recipient. Q 2005 The British Infection Society. Published by Elsevier Ltd. All rights reserved. Introduction Although the occurrence of perinephric abscess has been widely recognized as a possible complication of renal transplantation, there are few reports on its etiology. In a smallseries of cases, Staphylo- coccus spp., Enterobacteriaceae and Bacteroides spp. were the most common etiologic agents. 1 To our knowledge, based on a literature search (MED- LINE, 1966–2004),this is the first report of a perinephric abscess caused by Streptococcus aga- lactiae after renal transplantation. Case report A 36 year-old woman with long standing insulin- dependentdiabetes mellitus received a kidney graft from a HLA—identicaliving—related donor for chronic renalfailure due to diabetic nephro- pathy. Twelve months after transplantation she was admitted to the renal transplant unit reporting low- grade fever, anorexia, malaise and pain in the right lower quadrant of the abdomen for the preceding 3 weeks. During the 5 daysbefore admission,the abdominal pain became more intense, irradiating to the right lower limb, and a progressively enlarging tender massbecame apparentat the transplant site. Two weeks before the onset of fever, she had a skin abscess that was successfully treated with a seven-daycourse of cephalexin and drainage. Except for the occurrence of persistent hypergly- cemia and repeated episodesof asymptomatic Journal of Infection (2005) 51, e145–e147 www.elsevierhealth.com/journals/jinf 0163-4453/$30.00 Q 2005 The British Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jinf.2004.11.008 * Corresponding author. Address:Rua Justiniano da Rocha 201/302, Vila Isabel, CEP 20551 010 Rio de Janeiro, RJ, Brazil. Tel.: C55 21 2562 2725; fax: C55 21 2590 1615. E-mail address: santorolopes@hucff.ufrj.br(G. Santoro- Lopes).