An Uncommon but Serious Diagnosis Disguised as a UTI

​BY MATTHEW WU, & DEANDRE WILLIANS, MDA 2-year-old girl presented to the emergency department for abdominal pain with urination. She had been diagnosed with a urinary tract infection three days earlier, and was in the process of completing a course of antibiotics.The pain with urination made it difficult to void urine even when soaking in warm baths, according to the patient's parents. Her mother said the patient had to be bribed to drink anything. Their daughter did not urinate for 14 hours before arriving at our ED. They were concerned about dehydration due to the lack of fluid intake. The patient also refused to take her antibiotics for the UTI.The patient weighed 35 pounds, and her vital signs were a blood pressure of 100/65 mm Hg, a pulse of 125 bpm, and a temperature of 98.8°F. She appeared well-developed, well-nourished, and active. She tolerated food, had an intact appetite, and had not recently vomited or had bloody stools. It was thought that she was voluntarily holding her urine and avoiding liquids. Her abdominal exam was negative for tenderness and guarding.A sterile catheter was used to collect a sample for urine analysis, which revealed a large volume of urine. The sample contained squamous cells, erythrocytes, and ketones, with no signs of infection (no leukocytes or nitrites). Blood tests showed a white blood cell count of 17,800/ΜL, a platelet count of 423,000/ΜL, a C-reactive protein level of 11.7 mg/dL, and an erythrocyte sedimentation rate of 49 ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research