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Acute Lobar Nephronia: A Case Report and Literature Review.
J Emerg Med. 2013 Nov 25;
Authors: Conley SP, Frumkin K
Abstract
BACKGROUND: Patients with fever, vomiting, and abdominal pain commonly present to the emergency department, often generating a broad differential diagnosis. We describe the first reported case in the emergency medicine literature of acute lobar nephronia (ALN).
OBJECTIVES: To describe the presentation, evaluation, and management of acute lobar nephronia.
CASE REPORT: A healthy 27-year-old woman presented after 18 h of fever to 39.94°C (103.9°F), nausea, vomiting, and severe right-sided abdominal pain. Despite a normal urinalysis, a contrasted computed tomography scan of the abdomen and pelvis demonstrated right perinephric stranding, which was initially interpreted as pyelonephritis. A staff over-read the following day by a radiology body specialist confirmed "likely developing abscess," consistent with the diagnosis of acute lobar nephronia.
CONCLUSION: A normal urinalysis may move clinicians to dismiss a nephrogenic or urologic process. ALN is considered a midpoint in the spectrum of upper urinary tract infections between acute pyelonephritis and intrarenal abscess. Diagnosis may be difficult, and inpatient management, sometimes prolonged, is the norm.
PMID: 24286715 [PubMed - as supplied by publisher]