Acute Lobar Nephronia: A Case Report and Literature Review

Abstract

BackgroundPatients with fever, vomiting, and abdominal pain commonly present to the emergency department, often generating a broad differential diagnosis. We describe the first reported case in the emergency medicine literature of acute lobar nephronia (ALN). ObjectivesTo describe the presentation, evaluation, and management of acute lobar nephronia. Case ReportA healthy 27-year-old woman presented after 18 h of fever to 39.94°C (103.9°F), nausea, vomiting, and severe right-sided abdominal pain. Despite a normal urinalysis, a contrasted computed tomography scan of the abdomen and pelvis demonstrated right perinephric stranding, which was initially interpreted as pyelonephritis. A staff over-read the following day by a radiology body specialist confirmed “likely developing abscess,” consistent with the diagnosis of acute lobar nephronia. ConclusionA normal urinalysis may move clinicians to dismiss a nephrogenic or urologic process. ALN is considered a midpoint in the spectrum of upper urinary tract infections between acute pyelonephritis and intrarenal abscess. Diagnosis may be difficult, and inpatient management, sometimes prolonged, is the norm.