Atypical presentation of pyelonephritis in an infant

A male infant born at 28 5/7 gestational weeks with a birth weight of 1180 grams was admitted to the neonatal intensive care unit (NICU) due to prematurity, very low birth weight, and respiratory distress syndrome (RDS). At about three months of life, he remained inpatient while working on oral feeding skills. The infant presented with a gradual onset of consistently elevated blood pressure readings leading to a diagnosis of hypertension. While undergoing evaluation for the aetiology of hypertension, a renal ultrasound with Dopplers demonstrated findings consistent with pyelonephritis. The infant had no clinical manifestations of pyelonephritis. Additionally, an echocardiogram showed reduced cardiac function, likely a result of hypertension. Radiographic signs of pyelonephritis resolved following treatment of the pyelonephritis with antibiotics. An echocardiogram completed after the initiation of antihypertensive medication showed improvement in cardiac function. The infant was discharged home with multispeciality follow-up and is reportedly doing well. Per review of available literature, this is the first reported case of hypertension leading to a diagnosis of pyelonephritis in neonates or young infants.