ABSTRACT
Renal abscesses are uncommon in otherwise healthy children and adolescents who have no underlying renal structural anomalies. A previously healthy, immunocompetent, 14-year-old male without a history of abdominal trauma or urinary tract infection (UTI) was found to have a renal hematoma that became infected and developed into a renal abscess. He presented with a 2-day history of nausea, vomiting, fever and 1-day history of abdominal pain that radiated to the right flank. Clinical examination, blood work, and initial imaging indicated likely infection; however, findings were normal on urinalysis and urine culture had no growth. Complete blood count (CBC) showed a leukocytosis with a left shift. Renal ultrasound showed a 4-cm mass-like area of liquefaction in the upper pole of the right kidney, confirmed by abdominal computed tomography (CT) scan with and without contrast. Intravenous ceftriaxone was started and the patient continued to improve. He was discharged on hospital day 6 after remaining afebrile for over 20 hours and inflammatory markers continued to decrease. Intravenous ceftriaxone was continued, and oral clindamycin was added. Both antibiotics were discontinued on day 24 since onset of illness.
ABSTRACT
Rhabdomyolysis can occur because of multiple causes and account for 7% of all cases of acute kidney injury annually in the United States. Identification of specific cause can be difficult in many cases where multiple factors could potentially cause rhabdomyolysis. We present a case of 16-year-old male who had seizures and was given levetiracetam that resulted in rhabdomyolysis. This side effect has been rarely reported previously and like in our case diagnosis may be delayed.
ABSTRACT
Spontaneous pneumomediastinum is an uncommon condition in athletes. The most common cause of spontaneous pneumomediastinum is alveolar rupture into the bronchovascular sheath as a result of increased intrathoracic pressure. Epidural pneumatosis (pneumorrhachis) has been rarely associated with spontaneous pneumomediastinum. In this article, we describe a case of a 17-year-old male who presented with neck and chest pain that started 14 hours after a weight lifting session. He developed both a pneumomediastinum and epidural pneumatosis--an association that is rarely reported in a setting without trauma. To our knowledge, there have been only 5 case reports of pneumomediastinum precipitated by weight lifting. Improper breathing technique during weight lifting can increase the intrathoracic pressure and the risk of pneumomediastinum; hence, it is important that physicians and trainers who work with athletes provide instructions regarding proper breathing techniques during weight lifting. In addition to the case discussion, this article reviews spontaneous pneumomediastinum and epidural pneumatosis.
