Thasneem Lubana, Reddy Manasa, Reddy Mounika, Arora Abhishek J, Samprathi Madhusudan
Pediatrics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND.
Pediatric Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND.
Cureus. 2025 Jul 1;17(7):e87112. doi: 10.7759/cureus.87112. eCollection 2025 Jul.
Renal abscesses are rare in children. This report presents a case where a renal abscess due to methicillin-resistant (MRSA) was the initial indication of immunocompromised status in an adolescent boy. A 17-year-old male patient presented with a month-long history of fever, fatigue, and significant weight loss, along with dull aches and swelling in the left flank. There was no history of urinary symptoms, vomiting, or high-risk behaviors. His mother had died from sepsis while on antiretroviral therapy (ART), and his father from coronary artery disease. The patient had not been previously tested for human immunodeficiency virus (HIV). Examination revealed a tender fullness in the left lumbar region. Ultrasound showed a collection in the left kidney. Blood tests indicated anemia and elevated inflammatory markers. The patient tested positive for HIV antibodies. Empirical antibiotics were started. Ultrasound-guided aspiration grew MRSA, prompting a switch to vancomycin. A percutaneous catheter was inserted due to abscess recurrence. The patient received intravenous vancomycin followed by oral linezolid and started antiretroviral therapy. Repeat imaging at six weeks showed resolution of the abscess. Renal abscesses in children can be life-threatening and often result from urinary tract infections or hematogenous spread. This patient's abscess likely resulted from hematogenous spread due to immunocompromised status. Effective management, including prompt percutaneous drainage and targeted antibiotics, combined with ART, led to abscess resolution and a favorable outcome. This case underscores the importance of considering immunodeficiency in pediatric patients with unusual infections like renal abscesses and highlights the necessity of a multidisciplinary approach and aggressive management for complex infections in immunocompromised children.
肾脓肿在儿童中较为罕见。本报告介绍了一例病例，一名青少年男性因耐甲氧西林金黄色葡萄球菌（MRSA）引起的肾脓肿是其免疫功能低下状态的最初表现。一名17岁男性患者有长达一个月的发热、乏力和明显体重减轻病史，同时伴有左侧腰部隐痛和肿胀。无泌尿系统症状、呕吐或高危行为史。他的母亲在接受抗逆转录病毒治疗（ART）时死于败血症，父亲死于冠状动脉疾病。该患者此前未接受过人类免疫缺陷病毒（HIV）检测。检查发现左侧腰部有压痛性饱满。超声显示左肾有液性聚集。血液检查提示贫血和炎症标志物升高。患者HIV抗体检测呈阳性。开始经验性使用抗生素。超声引导下穿刺培养出MRSA，促使改用万古霉素。由于脓肿复发，插入了一根经皮导管。患者接受了静脉注射万古霉素，随后口服利奈唑胺，并开始抗逆转录病毒治疗。六周后复查影像学检查显示脓肿消退。儿童肾脓肿可能危及生命，通常由尿路感染或血行播散引起。该患者的脓肿可能是由于免疫功能低下状态导致的血行播散所致。有效的治疗，包括及时的经皮引流和针对性抗生素治疗，结合抗逆转录病毒治疗，导致脓肿消退并取得了良好的结果。该病例强调了在患有肾脓肿等不寻常感染的儿科患者中考虑免疫缺陷的重要性，并突出了对免疫功能低下儿童复杂感染采取多学科方法和积极治疗的必要性。
