• Keishu Murakami, Shinobu Tamura, Anna Maruyama, Tomomi Naitoh, Kan Teramoto, Yurina Mikasa, Masaoh Tanaka, Shinichi Murata, and Seiya Kato.
• Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama 641-8509, Japan.
• Medicina (Kaunas). 2022 Aug 5; 58 (8).

AbstractRenal leukemic infiltration is uncommon in myeloid neoplasms, including myelodysplastic syndromes (MDS). A 76-year-old male patient was admitted to our hospital with complaints of fever and dyspnea. He was diagnosed with MDS with multilineage dysplasia and acute focal bacterial nephritis (AFBN) based on clinical, laboratory, and radiological investigations. Antibiotic treatment temporarily improved his condition, but the radiological image of AFBN remained. His condition gradually deteriorated into multiple organ failure, and he unfortunately died on the 31st day of hospitalization. Autopsy findings revealed significantly increased p53-positive blasts in the bone marrow and renal parenchyma overlapping AFBN, suggesting leukemic transformation and renal infiltration. This case emphasizes the need to review the diagnosis when antibiotic treatment is ineffective in MDS patients with AFBN.

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