Bilateral multifocal acute lobar nephronia caused by Enterococcus faecalis

BMJ Case Rep. 2018 Apr 5:2018:bcr2018224336. doi: 10.1136/bcr-2018-224336.

Abstract

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.

Keywords: infectious diseases; paediatrics; urinary tract infections.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain
  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Enterococcus faecalis / isolation & purification*
  • Fever
  • Gram-Positive Bacterial Infections / diagnosis*
  • Gram-Positive Bacterial Infections / drug therapy
  • Headache
  • Humans
  • Male
  • Pyelonephritis / diagnostic imaging*
  • Pyelonephritis / therapy
  • Referral and Consultation
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Urinary Tract Infections / diagnosis*
  • Urinary Tract Infections / drug therapy
  • Vesico-Ureteral Reflux / diagnostic imaging*
  • Vesico-Ureteral Reflux / therapy

Substances

  • Anti-Bacterial Agents