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Bilateral multifocal acute lobar nephronia caused by Enterococcus faecalis
Yoshiki Kusama1,2, Kunio Muraki1,3
1Department of Paediatrics, Fuji City General Hospital, Shizuoka, Japan.
BMJ Case Reports
|April 7, 2018
Summary
A rare case of bacteraemic urinary tract infection caused by Enterococcus faecalis in an 8-year-old boy led to acute lobar nephronia (ALN). Prompt diagnosis and appropriate antibiotic therapy are crucial for successful treatment.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Radiology
Background:
- Bacteraemic urinary tract infections (UTIs) can lead to serious renal complications.
- Enterococcus faecalis is a potential pathogen in UTIs, particularly in pediatric cases.
- Acute lobar nephronia (ALN) is a severe form of pyelonephritis requiring careful management.
Observation:
- An 8-year-old boy presented with fever, epigastric pain, and headache, diagnosed with bacteraemic UTI due to Enterococcus faecalis.
- Initial antibiotic treatment with vancomycin and ampicillin was insufficient, with persistent fever.
- Contrast-enhanced CT (CECT) revealed bilateral, multiple wedge-shaped defects, indicative of ALN.
Findings:
- The patient's fever resolved after 7 days of continued antibiotic treatment for ALN.
- CECT features can differentiate between simple and complicated ALN, with complicated cases potentially showing delayed antibiotic response.
- Causative organisms for ALN exhibit regional variations, necessitating awareness of local microbiological patterns.
Implications:
- Understanding the natural course of complicated ALN is vital to avoid premature escalation of antibiotic therapy.
- Physicians should consider local microbiological data when diagnosing and treating ALN.
- Early and accurate diagnosis of ALN, supported by imaging, is essential for effective pediatric UTI management.
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