Pyelonephritis complicated by a perirenal abscess in a pregn
Acute pyelonephritis is the most common bacterial infection during pregnancy. If not diagnosed and treated promptly, it can lead to serious maternal and fetal complications. A 24-year-old patient with no medical history, pregnant at 24 weeks of amenorrhea, consulted our department for right lower back pain, fever, and chills evolving for 5 days. Clinical examination showed an altered general condition, lumbar fossa tenderness, hypotension, and tachycardia. The gynecological examination showed minimal intravaginal bleeding and fetal bradycardia. After transfer to the intensive care unit and stabilization of the hemodynamic state, the biological analysis showed the presence of anemia, renal failure, and an elevated CRP level. Ultrasound showed dilatation of the pyelocaliceal cavities without obstruction and a heterogenic appearance of the perirenal fat. After informing the family of the risk of maternal and fetal complications, the patient was put on antibiotics based on 3rd generation cephalosporins and she had drainage by a double-j stent. The initial urine culture was negative.

The evolution was marked by the persistence of fever and the appearance of severe pelvic pain on day 2 of treatment. Gynecological examination coupled with pelvic ultrasound confirmed the diagnosis of fetal death in utero. The patient had an induction of labor allowing the delivery of a fetus in an apparent state of death. After the delivery and in view of the persistence of the fever, the patient had a CT scan which showed the presence of a 7 cm right perirenal abscess. Percutaneous drainage of the abscess was performed. Bacteriological examination of pus showed the presence of Escherichia coli. The antibiotic therapy was prolonged for 4 weeks. The evolution was favorable and the patient was discharged after two weeks of treatment. She was referred to the department of psychiatry for psychological care.