Case Study

Emphysematous pyelonephritis in an infant from Sokoto, north-western Nigeria

Fatima B. Jiya, Paul K. Ibitoye, Nma M. Jiya, Maryam Amodu-Sanni, Yahaya Mohammed, Dada M. Aquib, Lukman K. Coker
African Journal of Laboratory Medicine | Vol 10, No 1 | a1181 | DOI: https://doi.org/10.4102/ajlm.v10i1.1181 | © 2021 Fatima B. Jiya, Paul K. Ibitoye, Nma M. Jiya, Maryam Amodu-Sanni, Yahaya Mohammed, Dada M. Aquib, Lukman K. Coker | This work is licensed under CC Attribution 4.0
Submitted: 27 January 2020 | Published: 26 April 2021

About the author(s)

Fatima B. Jiya, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Paul K. Ibitoye, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Nma M. Jiya, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Maryam Amodu-Sanni, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Yahaya Mohammed, Department of Medical Microbiology and Parasitology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Dada M. Aquib, Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Lukman K. Coker, Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria


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Abstract

Introduction: Emphysematous pyelonephritis is a life-threatening necrotising bacterial infection of the kidneys. It is rare among children and can be fatal if not promptly identified and treated.

Case presentation: A 7-month-old male infant presented to the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, on 12 November 2019 with a 5-day history of fever and vomiting, and a 3-day history of a progressively enlarging, left-side abdominal mass. There was associated excessive crying on micturition, refusal to feed and weight loss. He looked ill and was in respiratory distress, irritable, febrile (38.8 °C), moderately dehydrated and pale. His weight and length were 5.5 kg and 64 cm. He had a tender, firm and ballotable abdominal mass on the left flank measuring 8 cm × 10 cm. His pulse rate was 140 beats/min, blood pressure 60/40 millimetres of mercury and respiratory rate was 65 cycles/min. He had widespread coarse crepitations and normal heart sounds on chest auscultation.

Management and outcome: An initial diagnosis of sepsis was made. Other considerations were nephroblastoma and neuroblastoma. Ceftriaxone and blood transfusion were commenced with subsequent administration of intravenous fluids. Further radiologic investigations revealed emphysematous pyelonephritis. The patient had percutaneous drainage and extended spectrum β-lactamase-producing Escherichia coli (sensitive to meropenem) which was isolated from the aspirate culture after 48 h of incubation. Meropenem could not be commenced because of non-availability and high cost. The patient subsequently deteriorated and died from septic shock.

Conclusion: Emphysematous pyelonephritis has a fulminant course when not diagnosed promptly and treated adequately.


Keywords

Emphysematous pyelonephritis; infection; kidney; infant; Sokoto

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