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Renal abscess after the Fontan procedure: a case report
Anurag Mehrotra1, Pallavi Khanna, Suresh Kumar
1Department of Nephrology, Madras Medical Mission, Chennai, India. mehrotra.anurag@gmail.com.
Insights
A renal abscess, a rare complication, occurred in a patient nine years after Fontan surgery. Early diagnosis of kidney infections is crucial to prevent nephrectomy in Fontan physiology patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Nephrology
Background:
- The Fontan procedure corrects single ventricle physiology.
- Long-term complications of Fontan physiology are known but renal abscess is unreported.
- Awareness of long-term outcomes is crucial as the first adult generation undergoes the procedure.
Purpose of the Study:
- To report a case of renal abscess in a post-Fontan patient.
- To highlight the importance of recognizing renal abscess as a potential complication.
- To emphasize early diagnosis and treatment to prevent nephrectomy.
Main Methods:
- Case report of a 22-year-old male with a staphylococcal renal abscess.
- History of Fontan surgery nine years prior.
- Presented with prolonged fever; diagnosed with renal abscess via ultrasound and CT; treated with antibiotics and nephrectomy.
Main Results:
- A 22-year-old male developed a staphylococcal renal abscess and xanthogranulomatous pyelonephritis.
- The condition occurred nine years after Fontan surgery.
- Despite antibiotic treatment, a left nephrectomy was required due to abscess non-resolution.
Conclusions:
- Renal abscess is a possible complication in post-Fontan procedure patients.
- Early diagnosis of renal infection is vital.
- Prompt intervention may prevent the need for nephrectomy.
Introduction:
The Fontan procedure is an intervention that helps to correct single ventricle physiology. There are many known long-term complications of 'Fontan physiology'. However, the occurrence of renal abscess in such patients has not yet been reported in the literature. The first generation of adults has now undergone the procedure and it is necessary to be aware of the long-term outcomes and complications associated with it.
Case Presentation:
We report the case of a 22-year-old South Indian man who had developed a staphylococcal renal abscess against a background of xanthogranulomatous pyelonephritis, nine years after Fontan surgery. He presented to our hospital with a high-grade fever of 25-days duration but with no other symptoms. Physical examination identified costovertebral angle tenderness and pedal edema. An ultrasound scan revealed a mass in his left kidney. The results of a computed tomography scan were consistent with a renal abscess. Despite treatment with the appropriate parenteral antibiotics, there was no change in the size of the abscess and a left nephrectomy was performed as a curative procedure.
Conclusions:
The learning points here are manifold. It is important to be aware of the possibility of renal abscess in a post-procedural patient. The early diagnosis of a septic focus in the kidneymay help to prevent the rare outcome of nephrectomy.
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