[A pediatric case of acute focal bacterial nephritis; comparison with the reports in Japanese child cases]

Bilateral multifocal acute lobar nephronia caused by Enterococcus faecalis

An 8-year-old boy presented to our hospital with complaints of fever, epigastric pain and headache. Enterococcus faecalis were isolated from urine and blood culture, bacteraemic urinary tract infection was clinically diagnosed. Although vancomycin and ampicillin were administrated, fever did not subside. Contrast-enhanced CT (CECT) revealed bilateral and multiple wedge-shaped defects, thus prompting a diagnosis of acute lobar nephronia (ALN). After 7 days of antibiotic treatment, the patient's fever subsided. ALN can be classified into two subgroups based on features of CECT; simple and complicated ALN. The treatment response to antibiotics tends to be delayed in complicated ALN, it is important that we understand the natural course of complicated ALN and should not escalate antibiotics hastily. According to previous studies, ALN has a wide regional variety of causative organisms. Therefore, the physician should recognise a local pattern of microbiological aetiology of ALN.

Acute focal bacterial nephritis in an 8-year-old

Acute focal bacterial nephritis or acute lobar nephronia is an acute localized non-liquefactive bacterial kidney infection. Clinically, it may develop as an abscess and present as acute pyelonephritis but is distinguishable by the presence of a focal mass on imaging studies. The authors report the case of an 8-year-old girl with fever up to 39 degrees C and left flank pain of 6 days duration. On physical examination, she had nothing remarkable except tenderness and knocking pain over the left costovertebral angle. Post-contrast abdominal computed tomography revealed several wedge-shaped hypodense lesions in the left kidney. Urine culture grew Escherichia coli. Acute focal bacterial nephritis was diagnosed. The patient was treated with antibiotics and discharged on the 12th day of hospitalization.