An Unusual Presentation Of Pyelonephritis In An Adolescent
A 17 year old female with a prior history of pyelonephritis presented initially to outpatient clinic with sharp diffuse abdominal pain, nausea, vomiting, diarrhea, and fevers over the course of three weeks. She was also found to have a 20 lb weight loss over 6 months and initial labs showed moderate transaminitis, anemia (Hemoglobin 7.7), and UA suggestive of a UTI with Large Leukoesterase, 4+ Bacteria and >100 WBCs. She was admitted to the hospital for work up of symptomatic anemia, unintentional weight loss and transaminitis and was given 1 g of Rocephin in the ED for UTI. Initially there was concern for undiagnosed Inflammatory Bowel disease that may account for anemia, weight loss, transaminitis, abdominal pain and diarrhea. Had an abdominal CT not been performed where renal enhancement with mild right perirenal inflammation was seen the diagnosis of pyelonephritis may have been missed altogether. After receiving a unit of RBCs and proper treatment for pyelonephritis, she was able to be discharged home where an extensive work up by hematology revealed iron deficiency due to diet. She regained the weight within a month after discharge and her transaminases trended down to normal. The diagnosis of pyelonephritis was delayed in this patient because of her significant weight loss and anemia and too early narrowing of the differential for abdominal pain in a teenage girl. In this case due to the vague symptoms, abdominal imaging should have been performed earlier and would have helped narrow down the differential.