ABSTRACT
Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass without frank abscess formation. We report a case of acute focal bacterial nephritis without pyuria in a five-month-old boy presenting with high urinary ß2-microglobulin (ß2-MG) and N-Acetyl-ß-(D)-Glucosaminidase (NAG) levels. The infant initially presented with high-grade fever, and plain computed tomography (CT) showed a nearly isodense mass, and contrast-enhanced abdominal CT showed a wedge-shaped hypodense lesion. Enterococcus was detected in the subsequent urine culture. A diagnosis of AFBN was made on the basis of his high inflammatory reaction, contrast-enhanced abdominal CT findings and high urinary ß2-MG and NAG levels. He was treated with Ceftriaxone and subsequent improvement in inflammatory reaction and contrast-enhanced CT findings were observed. Voiding cystourethrogram (VCUG) showed a grade V right VUR. This case suggests that urinary ß2-MG and NAG levels may be useful additional markers for the diagnosis of AFBN without pyuria.
Subject(s)
Focal Infection/urine , Gram-Positive Bacterial Infections/urine , Nephritis/urine , Acetylglucosaminidase/urine , Anti-Bacterial Agents/therapeutic use , Biomarkers/urine , Ceftriaxone/therapeutic use , Enterococcus , Focal Infection/diagnostic imaging , Focal Infection/drug therapy , Gram-Positive Bacterial Infections/diagnostic imaging , Gram-Positive Bacterial Infections/drug therapy , Humans , Infant , Male , Nephritis/diagnostic imaging , Nephritis/drug therapy , Radiography , beta 2-Microglobulin/urineABSTRACT
Acute focal bacterial nephritis or acute lobar nephronia is an acute localized non-liquefactive bacterial kidney infection. Clinically, it may develop as an abscess and present as acute pyelonephritis but is distinguishable by the presence of a focal mass on imaging studies. The authors report the case of an 8-year-old girl with fever up to 39 degrees C and left flank pain of 6 days duration. On physical examination, she had nothing remarkable except tenderness and knocking pain over the left costovertebral angle. Post-contrast abdominal computed tomography revealed several wedge-shaped hypodense lesions in the left kidney. Urine culture grew Escherichia coli. Acute focal bacterial nephritis was diagnosed. The patient was treated with antibiotics and discharged on the 12th day of hospitalization.
