PMC6820168_01
(A) US showing increased echogenicity in the upper pole (arrow). (B) Power Doppler: hypoperfusion in the same area.
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APN. Abdominal ultrasound (Figure 1A) demonstrated a hyperechoic area at the upper pole of the right kidney with mild perinephric fluid and hypoperfusion in the same area by power Doppler (Figure 1B).
(A) CECT showing wedge-shaped area (Arrow). (B) After 2 weeks of treatment. C: At Day 24.
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Based on these imaging findings and the prolonged febrile period, AFBN was suspected and subsequently confirmed by CECT which revealed a wedge-shaped area with decreased enhancement (Figure 2A). Figure 2B shows the gradual improvement after 2 weeks and 24 days of antibiotic therapy (Figure 2C).
PMC6820168_02
(A) Multiple wedge-shaped lesions (Arrow: multifocal). (B) Complete resolution after 3 weeks of treatment.
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A CECT was obtained after 48 hours of persistent fever with rising CRP (303 mg/L), revealing multifocal wedge-shaped lesions (Figure 3A). CECT lesions in a highly septic patient and the fear of ESBL-producing pathogen confined to the kidney justified the use of meropenem which was followed by ertapenem as outpatient therapy. Complete resolution of the lesions was obtained after 3 weeks of treatment (Figure 3B).