Work-up After a First Febrile UTI: Is a Renal Ultrasound Sufficient?

Erin R. McNamara, MD; Caleb P. Nelson, MD, MPH

Disclosures

July 03, 2014

Case Presentation: An Infant Boy With Fever

A 6-month-old boy is brought to the emergency department with a fever at home of 38.5 °C (101.3 °F). He is otherwise healthy, born at 39 weeks gestation, and circumcised shortly after birth. A prenatal ultrasound was reportedly normal. The child's immunizations are up to date. The infant exhibits no grunting, flaring, vomiting, diarrhea, or rash. His mother states that he seems a bit fussy but has been taking feedings well with adequate wet diapers. The family reports no other symptoms. Coincidentally, the patient's older sister had a febrile urinary tract infection (UTI) as an infant with a negative work-up including a normal renal bladder ultrasound (RBUS) and a voiding cystourethrogram (VCUG) that showed no vesicoureteral reflux (VUR).

In the emergency department, the patient is flushed and somewhat lethargic but rouses appropriately, and his physical examination is normal. His temperature is 39.7 °C (103.1 °F), and other vital signs are within normal limits.

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