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A nine‐year‐old female patient presented with a two‐week history of vomiting, diarrhoea, abdominal pain, and a one‐week history of dysuria with macroscopic haematuria. There was no recent history of pharyngitis or a skin infection. Her past medical history included medication for attention deficit hyperactivity disorder, but no other significant conditions. On examination in the emergency department, the patient was tachycardic with heart rate 155 beats/minute (reference interval [RI], 70–130 beats/minute), febrile with temperature 38.8°C (RI, 36.4–37.4°C) and her abdomen was soft with generalised tenderness. There was no hypertension or evidence of oedema. Blood results showed leucocytosis with a white cell count of 15.7 × 10⁹/L (RI, 4.5–13.5 × 10⁹/L) and C‐reactive protein level of 110 mg/L (RI, < 3 mg/L). There was no associated evidence of toxic shock syndrome. Bedside urine analysis before antibiotic therapy showed leucocytes, blood and protein. The urine sample, as well as a blood and faecal samples were sent for microscopy and culture. Ultrasound scan of the kidneys, ureters and urinary bladder was unremarkable. The patient was admitted for presumed cystitis given little clinical evidence of glomerular nephritis and started on 750 mg intravenous cefazolin.

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Authors: Danjel Miladinovic and Warren Hargreaves

Article Type: Medical Education