A 6-year-old girl had an acute onset of abdominal pain and dysuria.
This had been preceded by four days of diarrhea and vomiting. Her medical history included a similar episode six months earlier that had subsided without treatment. She otherwise had had no symptoms attributable to her urinary tract.
Physical examination showed that the patient was at the tenth percentile for height and weight and was afebrile. She had tenderness and guarding of her lower abdomen.
The patient was admitted to the hospital and treated for a urinary tract infection with sulfamethoxazole-trimethoprim (Septrin).
Laboratory studies showed the patient had a hypochromic microcytic anemia (hemoglobin level, 9.2 g/dL) with normal renal function. An abdominal roentgenogram was obtained (Fig 1). Repeated urinalyses showed pyuria, with culture on one occasion yielding growth of Proteus vulgaris. An excretory urogram (Fig 2) and renal radionuclide scintiscan (Fig 3) were performed.
Denouement and Discussion