Ascending Urinary Tract Infection with Pyelonephritis in a Young Adult

Case at a Glance

A 27-year-old female presented with classic UTI symptoms that progressed to unilateral flank pain, suggesting ascending infection. Despite initial absence of fever, the patient developed rigors and was diagnosed with pyelonephritis.

Patient's Story

The patient reported a 3-day history of typical urinary tract infection symptoms including urinary frequency, incomplete bladder emptying, dysuria, and post-void throbbing pain. On day 2 of symptoms, she developed right-sided lower back pain described as throbbing and progressively worsening. Initially, she had no fever or hematuria. On the morning of day 4, she experienced uncontrollable shivering with alternating hot and cold sweats, prompting her to seek emergency medical care.

Initial Assessment

Patient presented with classic lower urinary tract symptoms (dysuria, frequency, urgency, incomplete emptying) progressing to unilateral flank pain. Initial absence of systemic symptoms (no fever, no hematuria) suggested uncomplicated UTI, but the development of flank pain raised concern for upper tract involvement.

The Diagnostic Journey

The patient initially consulted online for advice regarding the need for emergency care versus routine GP appointment. After developing rigors and diaphoresis, she contacted emergency services and was prescribed cephalexin empirically. When symptoms persisted after the second antibiotic dose, she presented to the emergency department where urinalysis confirmed renal involvement. Despite elevated temperature and systemic symptoms, sepsis was ruled out based on clinical assessment.

Final Diagnosis

Ascending urinary tract infection with acute pyelonephritis (kidney infection), confirmed by urinalysis showing renal involvement.

Treatment Plan

Empirical antibiotic therapy with cephalexin was initiated. Patient was advised to continue the prescribed antibiotic course and monitor for symptom improvement. Emergency department evaluation confirmed appropriate antibiotic selection and ruled out complications such as sepsis.

Outcome and Follow-up

Patient was discharged home with instructions to complete the antibiotic course and expect gradual symptom resolution. The case served as a learning experience for the patient regarding the importance of early medical intervention for UTI symptoms, particularly when systemic symptoms develop.