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Infectious Diseases
Utility of MRI in diagnosis and treatment of acute focal bacterial nephritis with abscess formation in a paediatric patient
  1. Yuhi Takagi1,
  2. Yuji Fujita1,
  3. Shigeko Kuwashima2 and
  4. Shigemi Yoshihara1
  1. 1Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
  2. 2Department of Radiology, Dokkyo Medical University, Tochigi, Japan
  1. Correspondence to Dr Yuhi Takagi; t-yuhi{at}dokkyomed.ac.jp

Abstract

Contrast-enhanced CT is the gold standard for the diagnosis of acute focal bacterial nephritis (AFBN). However, owing to radiation exposure and the possibility of contrast agent-induced side effects, contrast-enhanced CT is not always recommended for children. A paediatric patient presenting with a 1-week history of fever was admitted to our hospital. After a urine culture detected Escherichia coli, antimicrobials were administered; however, the fever had not resolved by the third day of hospitalisation. Renal diffusion-weighted MRI was performed and showed multiple wedge-shaped areas of high signal intensity in the right kidney. Additionally, the same site showed an area of low signal intensity in the apparent diffusion coefficient, and a diagnosis of AFBN with abscess was made. A chronic-phase technetium-99m-labelled dimercaptosuccinic acid renal scintigraphy was performed, but there was no renal scarring. MRI may be a more suitable tool for diagnosing AFBN given no radiation exposure.

  • Renal system
  • Urinary tract infections
  • Paediatrics

https://doi.org/10.1136/bcr-2023-257459

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: YT, YF, SK and SY. The following authors gave final approval of the manuscript: YF, SK and SY.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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