Acute Left-Sided Flank Pain with Fever - Self-Resolved Episode

Case at a Glance

A 23-year-old female presented with acute onset left flank pain, fever, and urinary symptoms that spontaneously resolved within hours, raising questions about the need for further evaluation.

Patient's Story

The patient experienced sudden onset of left-sided abdominal pain while at work that progressively worsened throughout her shift. The pain radiated to her left back and was significantly exacerbated during urination, described as a stabbing sensation. She developed associated symptoms including fever (subjectively feeling very hot and clammy), dizziness, and lightheadedness. By the end of her 8-hour work shift, the pain had largely subsided and she felt less feverish. At home, her temperature was 96.5°F. The following day, she reported only minimal residual back soreness with no fever or significant pain.

Initial Assessment

Young female with acute flank pain and constitutional symptoms suggestive of urological pathology. Patient is currently taking Vyvanse 50mg daily. No prior history of similar episodes or recent trauma. Symptoms resolved spontaneously without intervention.

The Diagnostic Journey

The clinical presentation of acute flank pain with radiation to the back, exacerbation with urination, and associated fever raised suspicion for nephrolithiasis (kidney stones) or urinary tract infection with possible pyelonephritis. The spontaneous resolution of symptoms suggested either passage of a small renal calculus or resolution of an infectious process.

Final Diagnosis

Suspected nephrolithiasis with spontaneous stone passage (differential diagnosis includes resolving urinary tract infection)

Treatment Plan

Patient chose conservative management with observation given symptom resolution. Recommendations included increased fluid intake, monitoring for symptom recurrence, and seeking medical attention if symptoms return or worsen.

Outcome and Follow-up

Symptoms resolved within 24 hours with only minimal residual back discomfort. Patient advised to follow up with primary care provider if symptoms recur, and to seek immediate medical attention for severe pain, persistent fever, or urinary retention. Some clinicians suggested that given the benign course and complete resolution, routine follow-up may not be necessary unless symptoms return.