Acute Pyelonephritis Associated with Ruptured Abdominal Aortic Aneurysm: An Unusual Presentation

  • Rafael Ferreira Nascimento Hospital Central do Funchal
  • Carolina Morna Internal Medicine Department, Hospital Central do Funchal, Funchal, Portugal
  • Mariana Bilreiro Internal Medicine Department, Hospital Central do Funchal, Funchal, Portugal
  • Ines Correia Internal Medicine Department, Hospital Central do Funchal, Funchal, Portugal

Keywords

Acute pyelonephritis, ruptured abdominal aortic aneurysm, abdominal ultrasound, C-reactive protein

Abstract

We describe a rare presentation of acute pyelonephritis associated with a ruptured abdominal aortic aneurysm. A 68-year-old female presented to the emergency department with a 3 day history of cystitis. General examination revealed the acute onset of pain in the left flank accompanied by fever and chills. Blood tests revealed leucocytosis 25,400x109L and C-reactive protein 495 mg/L (<6.1), while urinary sediment analysis revealed many leucocytes and gram-negative bacteria. The patient was admitted with acute pyelonephritis. On the third day of admission, the urine culture isolated Escherichia coli sensitive to the antibiotic prescribed; however, the patient clinically deteriorated. A computed tomography scan revealed a ruptured abdominal aortic aneurysm involving the left renal artery. The patient underwent an exploratory laparotomy but uncontrollable haemorrhage led to a fatal outcome.
This case highlights a rare case of acute pyelonephritis associated with a ruptured abdominal aortic aneurysm. A computed tomography scan or abdominal ultrasound should be considered whenever a patient has acute pyelonephritis with a C-reactive protein >400 mg/L in order to exclude complications and other potentially fatal pathologies.

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  • Published: 2020-03-11

    Issue: Vol 7 No 4 (view)

    Section: Articles

    How to cite:
    1.
    Nascimento RF, Morna C, Bilreiro M, Correia I. Acute Pyelonephritis Associated with Ruptured Abdominal Aortic Aneurysm: An Unusual Presentation. EJCRIM 2020;7 doi:10.12890/2020_001510.

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