Recurrent Urinary Tract Infections in a 3-Month-Old Male Infant

Case at a Glance

A 3-month-old male infant presenting with recurrent urinary tract infections, including one episode progressing to pyelonephritis requiring hospitalization. The patient also demonstrates feeding difficulties during illness episodes.

Patient's Story

The patient is a 3-month-old male infant (birth weight and length within normal parameters, currently 5.6kg and 59cm) who developed his first urinary tract infection at 6 weeks of age. This initial infection progressed to severe pyelonephritis, necessitating prolonged hospitalization. Despite initial imaging studies, the patient developed a second UTI at 3 months of age. The family reports concerns about recurrent infections in such a young infant. Additionally, the patient exhibits significant feeding difficulties during illness, requiring nasogastric tube feeding during a recent upper respiratory infection.

Initial Assessment

Initial presentation included fever, irritability, and signs consistent with urinary tract infection in a 6-week-old male infant. Laboratory findings confirmed UTI with subsequent progression to pyelonephritis requiring inpatient management.

The Diagnostic Journey

Renal ultrasound was performed to evaluate for structural abnormalities and showed no evidence of hydronephrosis or obvious anatomical defects. The ultrasound was repeated following the second UTI episode. Initial workup focused on ruling out vesicoureteral reflux, though comprehensive imaging including VCUG has not yet been completed. Referral to general pediatrics was initiated, with consideration for pediatric urology consultation.

Final Diagnosis

Recurrent urinary tract infections in male infant - etiology under investigation. Differential diagnosis includes vesicoureteral reflux, posterior urethral valves, or other genitourinary anatomical abnormalities.

Treatment Plan

Antibiotic treatment for acute UTI episodes. Comprehensive urological evaluation including voiding cystourethrogram (VCUG) to assess for vesicoureteral reflux and anatomical abnormalities. Referral to pediatric urology for specialized evaluation and management. Prophylactic antibiotic therapy may be considered pending further diagnostic results.

Outcome and Follow-up

Patient requires close monitoring with pediatric urology follow-up. Family education regarding signs and symptoms of UTI recurrence. Completion of comprehensive imaging studies including VCUG to guide long-term management strategy. Nutritional assessment may be warranted given feeding difficulties during illness episodes.