Periportal Edema as an Extrarenal Manifestation of Acute Pyelonephritis

TL;DR

This paper reports a case where acute pyelonephritis caused periportal edema, highlighting the importance of recognizing extrarenal signs for accurate diagnosis.

Contribution

The paper presents a novel case linking acute pyelonephritis with periportal edema and elevated hepatic enzymes.

Findings

CT confirmed acute pyelonephritis with periportal edema and elevated hepatic enzymes and C-reactive protein.

The patient's febrile episodes persisted for 4 days and resolved over two weeks despite antibiotic treatment.

Negative blood and urine cultures were likely due to prior antimicrobial use.

Abstract

Acute pyelonephritis is a common infection of the upper urinary tract that affects approximately 250,000 adults in the United States. Individuals with acute pyelonephritis require hospitalization and intravenous antimicrobial therapy. Diagnoses of acute pyelonephritis are made on the basis of clinical and laboratory findings. Individuals with complex or severe acute pyelonephritis undergo contrast-enhanced computed tomography (CT) for the diagnosis and assessment of perirenal abnormalities. However, extrarenal manifestations, such as periportal edema and gallbladder wall thickening, may complicate the diagnostic process. We report the case of a 42-year-old woman who presented with fever, dysuria, and flank pain—the hallmarks of urosepsis. CT results confirmed acute pyelonephritis accompanied by periportal edema and elevated levels of hepatic enzymes and C-reactive protein. Despite antibiotic intervention, febrile episodes persisted for 4 days and abated over a fortnight. The patient’s blood and urine cultures yielded negative results, which may be attributed to her prior antimicrobial treatment. Recognition of extrarenal signs in acute pyelonephritis is crucial for obtaining accurate diagnoses and understanding their clinical implications.

Figures