Paper
Case 2: A nine-year-old girl with prolonged fever and headache.
Published Apr 1, 2014 · T. Kollmann, T. Bhate, Keyvan Hadad
Paediatrics & child health
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Abstract
A previously healthy nine year-old girl presented to the authors’ institution (BC Children’s Hospital, Vancouver, British Columbia) with a four-week history of fevers, vomiting, headache and abdominal pain. She was first seen in a community hospital following a 24 h history of fever followed by headache, emesis and a generalized erythematous, macular rash. Petechiae were not noted. A diagnosis of viral gastroenteritis was made. The rash subsided quickly but the remainder of her symptoms persisted. Ten days later, she presented again to the same hospital with daily fevers, daily episodes of emesis and debilitating headaches. Her investigations included a normal complete blood cell count, and her urine culture was positive for Escherichia coli. She was discharged on cephalexin for five days; however, her symptoms failed to resolve. She was subsequently referred and admitted to the authors’ tertiary care centre. Review of her history revealed daily fevers accompanied by severe nausea and emesis, along with severe headaches without photophobia. There was no history of recent travel or ill contacts. She denied night sweats, neck stiffness or joint pain. Her records indicated a 5 kg weight loss over four weeks. Physical examination revealed a stable patient with normal vital signs. General examination was unremarkable and no neck stiffness or neurological deficit was detected. Laboratory investigations on admission showed leukocytosis (white blood cell count 11.2×109/L) and thrombocytosis (platelet count 423×109/L [normal range 150×109/L to 400×109/L]). Erythrocyte sedimentation rate was elevated (76 mm/h). Urine and blood cultures were negative. Abdominal ultrasound revealed a large echogenic right kidney, suggesting possible pyelonephritis. A computed tomography scan of the head and a chest radiograph were normal. A further investigation was performed to reveal the diagnosis.
Case ReportA nine-year-old girl with prolonged fevers, vomiting, and headaches was diagnosed with a rare form of pyelonephritis, requiring further investigation.
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