acute pyelo

[dodo24]

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hi i am a third year med student... i have a patient that no one knows what is wrong with. she has acute pyelo being treated with ceftriazone, she has had a fever of 103 on and off and now it is the 10th day of treatment. can anyone give any insight on to what is goin on thanks

 

[TexasRose]

First, no soliciting medical advice.

Second, we'd need a whole lot more information than that to even begin to give insight that your attendings don't already have. Come to think of it, how could we possibly offer insight that someone who knows her history and is currently following her case doesn't already have?

 

[deleted87716]

can anyone give any insight on to what is goin on

Mmm...maybe it isn't pyelo...? 😉

Ditto to what TexasRose said...you haven't given us much to go on.

 

[KidDoc29]

I would be concerned for an occult focus of infection. If she truly has pyelonephritis, has she developed a perinephric abscess? Was she uroseptic and bacteremic and then seeded a new area (hematogenous osteomyelitis, etc.) Is she growing a different bug besides garden variety E coli, such as enterococcus, an ESBL-producing Klebsiella, something else? I would start with an abdominal and pelvic CT, daily blood cultures while febrile, and consider a bone scan. Have you broadened her coverage? Have you isolated a bug?