A 28-year-old woman with a history of hypothyroidism and depression on treatment.
She presented 8 days of pain in the left flank and epigastrium, irradiating to the lumbar area, intensity 7/10 that partially subsided with analgesia, fatigue, feverish sensation not quantified, frontal headache and night sweats.
The patient was admitted with fever and hypotensive crisis, severe pain in the left flank and epigastrium, and mild decrease of right brachial and radial pulse.
Mild anemia, leukocytosis and mild thrombocytosis, ESR: 89 and CRP: 264.4 mg/l (VN < 10 mg/l) normal renal function, urinary sediment and liver profile stood out.
Abdominal and pelvic CAT scans revealed basal ganglia and pleural effusion.
Left kidney perfusion abnormality as a manifestation of acute pyelonephritis
She was hospitalized with a diagnosis of urinary sepsis and antibiotic treatment was initiated.
Hemoculture and uroculture were negative.
Kinetics of iron compatible with anemia of chronic diseases.
She continued with abdominal pain, elevated inflammatory parameters and fever up to 38°C. chest and neck aTAC: mediastinal, paratracheal, symmetrical subcarinal and bilateral hiliar lymph nodes.
Thoracic aorta with normal caliber, with parietal thickening in the arch and distal descending segment of inflammatory aspect, parietal thickening of the left subclavian artery.
He remained silent ET versus sarcoidosis.
Anti-DNA (-), C3 and C4 (normal), FR (-), direct Coombs (-), ANCA by IFI and ElRL)
Adenopathy biopsy: compatible with sarcoidosis.
Prednisone was prescribed in decreasing doses until suspension at 8 months.
At one year of follow-up, the patient is asymptomatic and with aCT and all normal tests.
