Miyahara Masazumi, Osaki Kyoko, Aoki Katsuya
Department of Pediatrics, Okanami General Hospital, Iga, JPN.
Department of Paediatrics, Okanami General Hospital, Iga, JPN.
Cureus. 2022 Aug 3;14(8):e27654. doi: 10.7759/cureus.27654. eCollection 2022 Aug.
Acute pyelonephritis is the leading cause of bacterial infection among children. It can be difficult to diagnose early in the disease course owing to non-specific symptoms and physical findings. Recently, some cases of pediatric acute pyelonephritis with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) have been reported. We describe a case of a six-year-old boy who presented with a high fever and four episodes of cluster convulsions. Despite the absence of leukocyturia and hypo-inflammatory response in the blood, he was diagnosed with acute pyelonephritis by contrast-enhanced computed tomography seven days after onset. The convulsions were not simple febrile convulsions and suggested central nervous system (CNS) lesions, as the patient was older than the usual cut-off age of five years for febrile seizures. This case highlights an unusual presentation and clinical course of a case of pediatric acute pyelonephritis characterized by cluster convulsions and a poor inflammatory response. Furthermore, we strongly consider that the cause of the cluster convulsions may be related to MERS spectrum disorder and emphasize that pyelonephritis can be accompanied by CNS disturbances.
急性肾盂肾炎是儿童细菌性感染的主要原因。由于症状和体征不具特异性，在疾病早期可能难以诊断。最近，有报道称一些小儿急性肾盂肾炎病例伴有轻度脑炎/脑病及可逆性胼胝体病变（MERS）。我们描述了一例6岁男孩，他出现高热和4次成串惊厥发作。尽管血液中无白细胞尿且炎症反应不明显，但发病7天后经增强计算机断层扫描诊断为急性肾盂肾炎。惊厥并非单纯热性惊厥，提示存在中枢神经系统（CNS）病变，因为该患者年龄超过了热性惊厥通常的5岁界限年龄。该病例突出了小儿急性肾盂肾炎以成串惊厥和炎症反应不佳为特征的不寻常表现及临床过程。此外，我们强烈认为成串惊厥的原因可能与MERS谱系障碍有关，并强调肾盂肾炎可伴有中枢神经系统紊乱。
