A 7-year-old girl with a one-year history of constipation, with no control or treatment.
The patient presented with two weeks of intermittent left iliac fossa pain, with no other associated gastrointestinal symptoms.
One week later, the pain migrated to the left lumbar region and began with polyuria, nocturia and bad odor urine.
The day before the consultation, the patient presented a thermal increase of 40°C axillary.
The emergency department showed good general condition, fever and no findings on segmental physical examination.
Laboratory tests showed leukocytosis of 18,300/mm3 (segmented 81%), CRP 89 mg/L and normal urinary sediment.
Urocultiva and two hemocultives were taken and subsequently reported as negative.
A chest X-ray was normal and an abdominal ultrasound showed only situs inversus abdominis, with no pathological findings in the kidneys.
Febrile stricture up to 39°C axillary, with pain in the left flank, normal stools and negative percussion pin test.
On the second day of hospitalization, complete blood count was monitored: 12,220 cells/mm3 (segmented 67%) and CRP 128 mg/L. On the third day, fever persisted, with positive renal percussion and pain on the left side
Antimicrobial treatment with cefoxime (150 mg/kg/day administered every 6 h) was initiated and renal scintigraphy with DMSA was requested, suggesting an acute left renal infection.
The fever decreased on the fourth day of antimicrobial therapy, with a decrease in inflammatory parameters.
The patient was discharged after seven days of intravenous treatment, maintaining treatment with cefadroxile for two additional weeks.
She came to outpatient follow-up and was asymptomatic.
