İdrar Yolu Enfeksiyonu ile Başvuran 5 Aylık Kız Hasta
Özet
Beş aylık bir kız hasta, huzursuzluk, ateş, kusma ve kötü kokulu idrar şikayetleriyle acil servise başvurmuş ve yapılan tetkiklerde lökositoz, akut faz reaktanlarında yükseklik ile idrarda nitrit pozitifliği saptanarak idrar yolu enfeksiyonu (İYE) ön tanısıyla yatırılmıştır. Annesinin vezikoüreteral reflü (VUR) nefropatisine sekonder böbrek nakilli olduğu öğrenilen hastanın yapılan idrar kültüründe Klebsiella pneumoniae üremesi saptanmış ve atipik İYE tanısı konulmuştur. Tedavisi amikasine revize edilen olguda klinik yanıt hızlıca alınmış, ateş kontrol altına alınmış ve enfeksiyon tablosu gerilemiştir. Atipik İYE ve ailede VUR öyküsü bulunması nedeniyle çekilen işeme sistoüretrografisinde (İSUG) sol evre IV ve sağ evre III VUR tespit edilmiştir. Hastaya trimetoprim-sulfametaksazol profilaksisi başlanmış; renal hasarı değerlendirmek amacıyla enfeksiyon sonrası 4. ayda çekilen DMSA sintigrafisi ise normal sınırlarda saptanmıştır. VUR, genetik geçiş özellikleri gösteren ve aile bireylerinde yüksek sıklıkta görülebilen bir hastalıktır. İlk aşamada konservatif tedavi yaklaşımıyla izlenen hastada, izlemin 24. ayında çekilen kontrol İSUG'da reflünün kendiliğinden tamamen kaybolduğu izlenmiş ve profilaksi tedavisi 2,5 yaşında sorunsuz şekilde kesilerek olgunun takibi başarıyla tamamlanmıştır.
A 5-month-old female patient presented to the emergency department with irritability, fever, vomiting, and foul-smelling urine, and was hospitalized with a presumptive diagnosis of urinary tract infection (UTI) after workup revealed leukocytosis, elevated acute phase reactants, and nitrite positivity. The patient, whose mother had a history of kidney transplantation secondary to vesicoureteral reflux (VUR) nephropathy, was diagnosed with atypical UTI after Klebsiella pneumoniae was isolated in urine culture. Following a treatment adjustment to amikacin, clinical improvement was promptly achieved, fever was controlled, and the infection subsided. Due to the atypical UTI and family history of VUR, a voiding cystourethrogram (VCUG) was performed, revealing grade IV VUR on the left and grade III VUR on the right. Trimethoprim-sulfamethoxazole prophylaxis was initiated, and a DMSA scintigraphy performed 4 months post-infection to evaluate renal damage was normal. VUR is a disease with hereditary traits and a high familial prevalence. Managed conservatively, the patient's follow-up VCUG at 24 months showed spontaneous resolution of the reflux, and antibiotic prophylaxis was successfully discontinued at 2.5 years of age.
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