Abstract
BACKGROUND: Corynebacterium urealyticum is a Gram positive, slow-growing bacterium that is a most commonly cause of encrusted cystitis. A major clinical problem is recurrent urinary tract infections with encrustation of the bladder mucosa especially for multimorbid individuals with weakened immune systems. CASE REPORT: We present the case of a 75-year-old male who was admitted to the urology department with perineal and urethral pain, dysuria, and macrohematuria. His medical history included complicated benign prostatic hyperplasia, vesical and splenic calculi, chronic cystitis, recurrent complicated urinary tract infections, and multiple prior urological interventions.Cystoscopy demonstrated nonspecific inflammation, incrustation of the bladder mucosa and prostatic area, and multiple bladder stones. Urine culture identified Corynebacterium urealyticum, which was susceptible to vancomycin. The patient received a 7-day course of vancomycin; however, no clinical improvement was observed.Surgical debridement of the urethral and bladder mucosa was subsequently performed, followed by a 2-week course of vancomycin. The patient's clinical condition improved markedly after this combined approach. CONCLUSION: This case highlights the importance of considering rare infectious agents in patients with recurrent urinary tract infections, particularly in those with a history of multiple hospitalizations and broad-spectrum antibiotic exposure. Infectious calculi can act as a persistent source of infection and may not respond to systemic antibiotic therapy alone. In such cases, surgical debridement of the mucosa is essential to achieve effective treatment. LEARNING POINTS: Elderly or multimorbid patients with recurrent or refractory urinary tract infections should be evaluated for Corynebacterium urealyticum, especially if they have had previous urological procedures, chronic catheterization or persistent bladder inflammation.Mucosal encrustation and infectious calculi function as chronic foci of infection, reducing the effectiveness of systemic antibiotic therapy alone and contributing to persistent or relapsing symptoms.A multimodal approach, including accurate microbiological identification, targeted antimicrobial therapy and endoscopic removal of encrustations and calculi, is needed to organize the best management of encrusted cystitis.