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SSRI‐INDUCED SIADH IN OLDER PEOPLE

C. Christe, N. Vogt
Published 1999 · Medicine

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of 4 out of 30. He had a temperature of 97.3" F, heart rate of 76, and his blood pressure was 132/60. Examination of his heart, lungs, and abdomen was unremarkable. His prostate was diffusely enlarged with no border palpable on the left; there were no discrete nodules. Laboratory studies were remarkable for a urinalysis that showed pH 5, specific gravity 1.010,17 red blood cells, >500 white blood cells, and many bacteria. His BUN was 39, and creatinine was 2.6. A urine culture grew Group B streptococci. The cultured Group B streptococci was presumed to be a contaminant, and the patient's antibiotic coverage did not include Group B streptococci. The patient returned to the emergency room 4 days later with a 1-day history of fever and increased agitation,. The patient's vital signs included a temperature of 102.2" F, heart rate 126, and blood pressure of 108/68. The laboratory studies were not significantly changed except for a white blood cell count of 13.1 with 92% neutrophils, 3% lymphocytes, and 4% monocytes. Two sets of blood cultures and a urine culture all grew Group B streptococci. The patient promptly defervesced on penicillin with a concomitant improvement in cognitive functioning to baseline. However, the patient's renal function did not improve with hydration or Foley catheter placement, and a renal ultrasound was obtained. This showed a normal right kidney, but the left kidney had marked dilation of the calyces and renal pelvis. A nephrostomy tube was placed to relieve this obstruction, which was presumed secondary to the patient's prostate cancer. The creatinine subsequently fell to 1.8. Group B streptococcus is a common pathogen in neonates and pregnant women, but it has also infrequently been reported to cause disease in adult males and nonpregnant females. The most common of these infections include pneumonia and bacteremia in older persons, but the spectrum of such infections is diverse and includes endometriosis, cellulitis, endocarditis, peritonitis, arthritis, meningitis, osteomyelitis, and urinary tract infection^.'-^ In nearly all reported cases of Group B streptococci infection in nonpregnant adults, there were underlying illnesses that predisposed to infection, most commonly diabetes or genitourinary abnormalit ie~.~-~ Although Group B streptococci frequently colonize the urinary tract, they rarely cause infection. In three prospective studies in large teaching hospitals, Group B streptococci was found to cause .6-2% of all culture-positive urinary tract infection^.^-^ In two of these studies, the characteristics of the affected patients were described. The majority of the patients were women (85-90%), and most of the women (>90%) and all of the men had at least one underlying condition. In the men, this was almost always urinary tract instrumentation or an abnormality such as obstruction, renal calculi, or cystic kidneys. Group B streptococci is commonly presumed to be a contaminant when isolated from the urine of nonpregnant adults. However, this case and the studies described above demonstrate that Group B streptococci can be a urinary pathogen in this population. Furthermore, urinary tract infection with this organism should prompt investigation for urinary tract abnormalities, especially in adult males.
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