Related Experiment Videos
A child with spider bite and glomerulonephritis: a diagnostic challenge
1Division of Dermatology, Department of Internal Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA.
International Journal of Dermatology
|May 16, 2000
Summary
A pediatric case initially suspected as a brown recluse spider bite evolved into a diagnosis of poststreptococcal glomerulonephritis, complicated by hydronephrosis. This highlights the importance of considering varied etiologies in pediatric presentations.
Area of Science:
- Pediatric Nephrology
- Dermatology
- Infectious Disease
Background:
- A previously healthy 7-year-old boy presented with symptoms initially suggestive of a brown recluse spider bite.
- The patient exhibited a purpuric plaque on his calf, fever, and malaise.
Observation:
- Initial presentation included a tender, erythematous, purpuric plaque on the calf with surrounding erythema and inguinal lymphadenopathy.
- Laboratory findings revealed an elevated white blood cell count and fibrinogen, with urinalysis showing protein and red blood cells.
- Blood cultures yielded coagulase-negative Staphylococcus epidermidis, considered a contaminant, and the skin lesion showed signs of necrosis and peeling.
Findings:
- Despite initial suspicion of a spider bite and treatment with antibiotics, the patient developed hematuria, prompting investigation for nephritis.
- Elevated anti-streptolysin-O titer and low C3 levels confirmed poststreptococcal glomerulonephritis as the diagnosis.
- Renal ultrasound revealed severe left hydronephrosis with cortical atrophy, indicating ureteropelvic junction obstruction.
Implications:
- This case underscores the diagnostic challenge in differentiating between cutaneous emergencies like spider bites and systemic conditions in children.
- The co-occurrence of poststreptococcal glomerulonephritis and congenital hydronephrosis highlights the need for comprehensive evaluation in pediatric patients with complex presentations.
- Early recognition and appropriate management of both infectious and congenital urinary tract abnormalities are crucial for optimal patient outcomes.