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- W3205048494 abstract "<h3></h3> Case presentation: a 14 year-old female patient presents with fever (39.8 degrees Celsius), emesis and abdominal pain. Fever started four days earlier, was unremitting to antipyretics and prompted an initial ED visit after two days when leukocytosis with neutrophilia (17.17 x 103/mm3 and 14.31 x 103 respectively), elevated CRP (108.4 mg/L), minimal leukocyturia and hematuria (25/mm3 and 10/mm3 respectively)were noted. A chest X-ray was performed showing left pachypleuritis. Oral Ciprofloxacin was prescribed and the patient was discharged. Symptoms persisted despite five doses of antibiotic prompting return to the ED after two days. She was admitted on suspicion of UTI. Of note: 4 months prior she describes an episode of left inferior lobar pneumonia with pleural effusion that required drainage. Clinical exam was relatively normal: no hemodynamic instability, dysuria or lumbar pain. New laboratory tests were ordered and revealed leukocytosis with neutrophilia (15.92 x 103/mm3 and 12.68 x 103/mm3 respectively), rising CRP (155.7 mg/L), leukocyturia (50/mm3), proteinuria (75 mg/dL) and hematuria (25/mm3). Urine culture was negative. Renal ultrasound revealed slight right pyelectasia. Pyelonephritis with unkown agent was diagnosed and IV Ceftriaxone 70 mg/kg once daily was started. During the next three days the patient had frequent fever episodes and continuously rising CRP (193 mg/L) and leukocytes (19 x 103/mm3). Antibiotic therapy is changed to Meropenem 60 mg/kg/day t.i.d. Fever continues and chest tightness is described. Further tests are ordered: blood cultures (negative), chest X-ray (left basal opacity interpreted as possible pleural effusion is noted), ESR (100 mm/h), fibrinogen (625 mg/dl), C3, C4, circulating immune complexes, rheumatoid factor, p-ANCA, c-ANCA, antinuclear antibodies, anti-dsDNA antibodies, QuantiFERON TB gold, HIV serology (negative) and a metabolic panel. Creatinine and urea are elevated (4.22 mg/dl and 87 mg/dl respectively). Fractional excretion of sodium is 1.6% suggesting tubular damage. No sign of nephritic syndrome is noted and diuresis is normal. With supportive measures creatinine and urea values decrease (2.72 mg/dl and 57 mg/dl respectively). Chest echography reveals a 21mm-thick pleural effusion. QuantiFERON TB gold test is positive prompting transfer to a specialized tuberculosis clinic. On patient follow-up kidney function returned to normal after specific TB reatment. Renal TB is noted in literature, but the age and immune status of the patient, the clinical presentation, confounding laboratory findings and associated acute kidney injury with interstitial nephritis are of particular interst. Rare forms of renal TB (such as membranoproliferative glomerulonephritis) are noted, but usually in old and/or immunocompromised patients." @default.
- W3205048494 created "2021-10-25" @default.
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- W3205048494 date "2021-10-01" @default.
- W3205048494 modified "2023-09-26" @default.
- W3205048494 title "365 A rare form of tuberculosis presentation" @default.
- W3205048494 doi "https://doi.org/10.1136/archdischild-2021-europaediatrics.365" @default.
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