CASE STUDIES
THE YOUNG WOMAN WITH ACUTE URINARY "NON COMPLICATED" UPPER TRACT INFECTION: A DIAGNOSTIC PATHWAY
by
G.B. Piccoli
 |
Dr
G.B. Piccoli Chair of Nephrology University of Turin Turin, Italy |
On November 24th 2003, a 46 year old Caucasian woman called her old nephrologist friend late at night, asking for advice.
Seven days before (November 18th), she had experienced a cystitis-like infection, with severe lower urinary tract symptoms, mild fever, and abdominal discomfort. Her family physician had prescribed a fluorquinolone (levofloxacin 500 mg/day), which she had been taking since November 20th, with relief of the lower urinary tract symptoms, but with persistence of mild fever. Despite the continuation of antibiotic therapy, in the last couple of days flank pain progressively appeared and fever increased up to 40°C. Early the next morning, she was initially evaluated as outpatient and immediately referred to the Emergency ward for tests and therapy.
At the outpatient control, her old friend found a suffering, febrile and anxious young woman with severe spontaneous left flank pain and exquisite tenderness; the abdomen was diffusely tender and she reported severe malaise and nausea, increasing over the last few days. No urinary symptom was present and the bladder percussion elicited no discomfort.
Her past and recent clinical history was uneventful; the only surgical operation reported was subtotal thyroidectomy for goiter; since then she had been on L-thyroxin therapy. Besides the occasional use of non-steroidal anti-inflammatory agents, she regularly took antidepressive agents (delorazepam 2 mg and venlafaxine 150 mg). No voluptuary habits besides heavy smoking was reported (about one pack/day). She had never suffered from urinary tract infections, and febrile episodes similar to the one presently experienced had never been reported.
Question 1
