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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).
What is the most likely diagnosis?
Acute focal bacterial nephritis
Acute focal bacterial nephritis …
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.