Pre-school female, 3 years 8 months old, without morbid history, with PNI vaccines a day and attendance to kindergarten.
She presented with fever of up to 40°C in the axillary region for less than 24 h, two episodes of vomiting in food, rhinorrhea and frontal headache.
She presented visual disturbance during fever.
The Emergency Department (ED) showed fever, falls, with a normal segmental and neurological examination.
Laboratory tests showed leukocytosis of 36,100 cc/m3 (25% segmented), CRP 205 mg/L (normal value < 10), normal urine and chest X-ray with low interstitial infiltrate.
She was hospitalized with a diagnosis of febrile syndrome without focus.
The patient presented with persistent fever, regular general condition, with no evident focus on physical examination and elevated inflammatory parameters.
A probable Pneumococcal pneumonia was suspected; however, a chest X-ray showed no evidence of pulmonary consolidation.
Antimicrobial treatment was initiated with intravenous ampicillin.
100 mg/kg/day administered every 6 h after the administration of blood products.
The study was complemented with a viral panel (by immunofluorescence) of nasopharyngeal aspirate, urine culture, CSF study and blood cultures that were negative.
Percutaneous fever, after 48 h of antimicrobial therapy, an abdominal ultrasound was performed which showed renal replacement, with a larger left kidney, more globulous aspect and greater echogenicity.
Antimicrobial therapy was adjusted to ceftriaxone 50 mg/kg/day once a day, due to suspicion of urinary focus and a renal scintigraphy with DMSA (dimercaptosuccinic acid) was requested.
Fever subsided on the fourth day of treatment with ceftriaxone, together with a decrease in inflammatory parameters.
She was discharged on the seventh day, in good clinical condition, with the diagnosis of left nephronia.
He received cefadroxile 30 mg/kg/day for seven days, completing 14 days of total antimicrobial treatment.
The patient was followed up at the Infectious Diseases and Nephrology polyclinic with favorable evolution.
