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A young woman with fever and low back pain
  1. Yasuhiro Suyama1,
  2. Hiroyuki Inaba2,
  3. Ryota Inokuchi3
  1. 1Divison of Rheumatology, JR Tokyo General Hospital, Tokyo, Japan
  2. 2Department of Urology, JR Tokyo General Hospital, Tokyo, Japan
  3. 3Department of General and Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
  1. Correspondence to Dr Yasuhiro Suyama, Division of Rheumatology, JR Tokyo General Hospital, 2-1-3 Yoyogi Shibuya-Ku, Tokyo 151-8528, Japan; y-suyama{at}

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Clinical introduction

A previously healthy, 20-year-old woman taking oral contraceptives presented to the Emergency Department (ED) with fever (body temperature, 39.2°C) and low back pain. Physical examination showed right costovertebral angle tenderness. Laboratory tests revealed elevated white blood cell count (13.2×109/L) and C-reactive protein level (9.75 mg/dL). Coagulation test results were unremarkable except for D-dimer level (1.5 μg/mL). Urinalysis results were normal. Abdominal CT with contrast was performed (figure 1).

Figure 1

CT scan with contrast.


What is the most likely diagnosis?

  1. Renal infarction

  2. Acute focal bacterial nephritis

  3. Renal Abscess

  4. Antiphospholipid syndrome

Answer: B

Acute focal bacterial nephritis …

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  • Collaborators Dr Shirakwa, Dr Hagiwara and Dr Okuyama contributed to patient management.

  • Contributors All authors contributed to patient management. YS drafted the initial manuscript. All authors contributed to writing the manuscript. All the authors have provided written consent for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Institutional Review Board at JR Tokyo General Hospital.

  • Provenance and peer review Not commissioned; internally peer reviewed.