Acute lobar nephronia: a case report and literature review

Patients with fever, vomiting, and abdominal pain commonly present to the emergency department, often generating a broad differential diagnosis. We describe the first reported case in the emergency medicine literature of acute lobar nephronia (ALN).

To describe the presentation, evaluation, and management of acute lobar nephronia.

A healthy 27-year-old woman presented after 18 h of fever to 39.94°C (103.9°F), nausea, vomiting, and severe right-sided abdominal pain. Despite a normal urinalysis, a contrasted computed tomography scan of the abdomen and pelvis demonstrated right perinephric stranding, which was initially interpreted as pyelonephritis. A staff over-read the following day by a radiology body specialist confirmed "likely developing abscess," consistent with the diagnosis of acute lobar nephronia.

A normal urinalysis may move clinicians to dismiss a nephrogenic or urologic process. ALN is considered a midpoint in the spectrum of upper urinary tract infections between acute pyelonephritis and intrarenal abscess. Diagnosis may be difficult, and inpatient management, sometimes prolonged, is the norm.