Streptococcus pneumoniae as an Etiology of Urinary Tract Infection in a Patient with Obstructive Uropathy and Chronic Kidney Disease: A Rare Case Report

Abstract

Streptococcus pneumoniae is an exceptionally uncommon cause of urinary tract infection (UTI) in adults and is often dismissed as a contaminant when isolated from urine specimens. Structural abnormalities of the urinary tract and impaired host immunity may predispose to infection with such atypical pathogens. A 70-year-old hypertensive male with benign prostatic enlargement (BPE), obstructive uropathy, and chronic kidney disease (CKD) presented with fever, urinary incontinence, and flank pain. Urinalysis demonstrated marked pyuria, and urine culture yielded pure growth of S. pneumoniae at a colony count of 1 × 10⁵ CFU/mL. The isolate was susceptible to all tested antimicrobial agents. Laboratory evaluation revealed a leukocyte count of 8.9 × 10³/μL with neutrophilic predominance and a serum creatinine level of 2.07 mg/dL. Ultrasonography showed BPE with bilateral hydronephrosis. The patient responded favorably to amoxyclav and urological management. This report highlights S. pneumoniae as a rare but clinically significant uropathogen in elderly patients with obstructive uropathy and CKD. Recognition of pneumococci as true urinary pathogens in appropriate clinical settings is essential to ensure timely diagnosis and targeted therapy.

Bangladesh Journal of Medical Microbiology, January 2026;20 (1):66-69