BMJ Case Reports 2018; doi:10.1136/bcr-2018-224336
  • Reminder of important clinical lesson

Bilateral multifocal acute lobar nephronia caused by Enterococcus faecalis

  1. Kunio Muraki1,3
  1. 1Department of Paediatrics, Fuji City General Hospital, Shizuoka, Japan
  2. 2AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
  3. 3Department of Paediatrics, The Jikei University School of Medicine, Tokyo, Japan
  1. Correspondence to Dr Yoshiki Kusama, stone.bagle{at}
  • Accepted 21 March 2018
  • Published 5 April 2018


An 8-year-old boy presented to our hospital with complaints of fever, epigastric pain and headache. Enterococcus faecalis were isolated from urine and blood culture, bacteraemic urinary tract infection was clinically diagnosed. Although vancomycin and ampicillin were administrated, fever did not subside. Contrast-enhanced CT (CECT) revealed bilateral and multiple wedge-shaped defects, thus prompting a diagnosis of acute lobar nephronia (ALN). After 7 days of antibiotic treatment, the patient’s fever subsided. ALN can be classified into two subgroups based on features of CECT; simple and complicated ALN. The treatment response to antibiotics tends to be delayed in complicated ALN, it is important that we understand the natural course of complicated ALN and should not escalate antibiotics hastily. According to previous studies, ALN has a wide regional variety of causative organisms. Therefore, the physician should recognise a local pattern of microbiological aetiology of ALN.


  • Contributors YK wrote the manuscript. KM diagnosed the patient and wrote the draft of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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