FLANK PAIN AND FEVER IN A MAN
by Cristiana Rollino Department of Nephrology, S.G. Bosco Hospital. Turin. Italy Address correspondence to: Dr. Cristiana Rollino Nefrologia Ospedale S.G. Bosco P.za Donatore di Sangue 3 10154 Torino Italy Tel 390112402287 FAX 390112402458 cristiana.rollino@libero.it
HISTORY Besides hypertension, since May 2000, no relevant elements were recorded in the patient history (59 years old). In October 2005 serum creatinine was 1.2 mg/dl, hematuria was found in the urinary sediment and PSA was slightly elevated (7.1 ng/ml). In November 2005 the patient complained of a fever of up to 40°C with dysuria and left flank pain. He was given paracetamol and levofloxacin but, as the symptoms did not clear up, he presented to the Emergency Department. Blood pressure was 130/80 mmHg, heart rate 60/min, Oxygen saturation 98%, body temperature 40°C; no other abnormal signs were evident at physical examination; Giordano’s sign was positive on the left. Serum creatinine was 2.3 mg/dl, leukocytes 18700/mm3, hemoglobin 11.5 g/dl, platelets 135000/mm3, C-Reactive Protein 27 mg/dl, albuminemia 2.8 g/dl. 50 white blood cells/hmf and 50 red blood cells/hmf were found in the patient’s urine. Blood cultures were negative, urine cultures showed E. coli 106 cfu/ml. Proteinuria was 0.4 g/die. ECG: normal cardiac rhythm. Chest X-Ray was normal. Renal sonography showed a normal aspect of the renal parenchyma. The bladder had a normal echographic aspect. No pathological images were evident.
Question 1) - Which was the most probable diagnosis? (Only ONE answer is correct)