A 50-year-old man sought medical attention two years before a nephrological evaluation, complaining of pain in the right iliac and suprapubic fossa, nausea, vomiting and intense dysuria. He had no hematuria, fever, or weight loss. After consultation with an urologist, he used ciprofloxacin and tamsulosin for seven days. With no symptom improvement, the treatment regimen with ciprofloxacin was extended for another 14 days. The following exams were ordered in the investigation: urinary tract ultrasonography, prostate-specific antigen dosage and urodynamics, which results remained within the normality range. Urinalysis showed a pH of 7 and numerous pyocytes, and the erythrocyte sedimentation rate was 75 mm/1st hour. Computed tomography and ultrasound images of the abdomen revealed discrete renal pelvic ectasia and prostate calcifications. The initial physical examination of the nephrological evaluation did not detect significant alterations besides discomfort to deep palpation in the hypogastric region. Inflammatory markers, urine culture, and EAS were requested for control purposes. Two months later, the patient returned for consultation complaining of persistent dysuria, bladder discomfort (pressure), voiding urgency, and nocturia. The urine culture resulted positive for M. abscessus. The biochemical tests revealed a reduction of nitrate (-), β-glycosidase (-), 5% tolerance to sodium chloride (+), sodium citrate (-), fructose fermentation (-), mannitol fermentation (-); picric acid (+) and Tween 80 hydrolysis (+).
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