Lactobacilli are normal colonizers of the oropharynx, gastrointestinal tract, and vagina. Infection is rare, but has been reported in individuals with predisposing conditions. Here we describe the case of a woman with pyelonephritis and bacteremia in which Lactobacillus delbrueckii was determined to be the causative agent. 1. Introduction Lactobacilli are ubiquitous commensal gram positive rods that colonize the mucosal surfaces of the oropharynx, gastrointestinal tract, and vagina. Although rare, reports have shown lactobacilli to cause bacteremia [1], subacute endocarditis [1, 2], urinary tract infections [3, 4], meningitis [5], chorioamnionitis [2], endometritis, abscesses, and dental caries [1]. The true prevalence of lactobacilli infection is likely underreported in the medical literature as the bacterium is typically regarded as commensal or contamination when identified. To our knowledge, this is the first case of pyelonephritis and bacteremia caused by L. delbrueckii. We review the literature to identify key risk factors for Lactobacillus bacteremia from a renal source including: urolithiasis, diabetes, cancer, and recent use of certain antibiotics. Here we describe our case to demonstrate significant illness in an individual with multiple predisposing conditions. 2. Case Report A 68-year-old woman presented to the emergency department with fever, chills, nausea, and vomiting. She was diagnosed with a urinary tract infection by urinalysis and discharged home on ciprofloxacin 500？mg twice daily. She returned the following day with persistent fevers, chills, nausea, vomiting, and new onset confusion, diaphoresis, abdominal and left-sided flank pain. Her significant past medical history included uncontrolled type 2 diabetes mellitus, hypothyroidism, chronic obstructive pulmonary disease (COPD), and tobacco use. On examination, the patient was febrile (39.4°C), hypotensive (75/20？mmHg), tachycardic (pulse 104 beats/minute), tachypneic (respiratory rate 24/minute), and hypoxic (oxygen saturation of 78% on room air). She was confused and appeared fatigued. Left-sided costovertebral angle tenderness and suprapubic tenderness were noted. Laboratory data showed a normal white cell count (of 5.0 × 109/L). Blood glucose was elevated at 362？mg/dL (normal 70–110？mg/dL). Blood urea nitrogen and creatinine were elevated at 28？mg/dL (normal 10–20？mg/dL) and 1.7？mg/dL (normal 0.6–1.1？mg/dL), respectively. Urinalysis showed a pH of 5 (normal 5–8), negative nitrites, 3 plus leukocyte esterase/high powered field (hpf), 20–30 white blood cell (WBC)/hpf and glucose
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