Four Cases of Acute Focal Bacterial Nephritis with Neurological Symptoms

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  • Saito Katsuya
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Fuchigami Tatsuo
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Hasegawa Maki
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Imai Yuki
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Hashimoto Koji
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Fujita Yukihiko
    Division of Medical Education Planning and Development, Nihon University School of Medicine
  • Inamo Yasuji
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Mugishima Hideo
    Department of Pediatrics and Child Health, Nihon University School of Medicine

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Other Title
  • 中枢神経症状を呈した急性巣状細菌性腎炎の検討
  • 症例報告 中枢神経症状を呈した急性巣状細菌性腎炎の検討
  • ショウレイ ホウコク チュウスウ シンケイ ショウジョウ オ テイシタ キュウセイ ソウジョウ サイキンセイジンエン ノ ケントウ

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Abstract

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney. Patients present with an inflammatory mass without frank abscess formation, and may represent a relatively early stage renal abscess. We report 4 cases of AFBN with neurological symptoms, including meningeal irritation, unconsciousness and seizure. Each of the 4 patients had hyperleukocytosis and elevated levels of C-reactive protein. Two patients had neck stiffness. However, cerebrospinal fluid findings from all 4 patients were normal. Initial urinalysis showed leukocyturia in patient 1, whereas no abnormalities were observed in the other patients. Patients 1 and 3 exhibited unconsciousness and mild brain edema, as observed on cranial computed tomography (CT). Abdominal enhanced CT was indispensable for the diagnosis of AFBN in these patients. Hence, we recommend that enhanced CT should be performed for patients with fever of unknown origin.

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