Case 38-1989

Presentation of Case A 19-year-old man was admitted to the hospital because of fever, left upper abdominal pain, anemia, and weight loss. He was well until six weeks earlier, when left flank pain developed, with a sensation of chilliness; there was no antecedent trauma, and no urinary tract symptoms were recalled. A physician found that the patient was afebrile and noted the absence of flank tenderness. The weight was 66.8 kg. Urinalysis showed + + red cells and + white cells; a culture yielded less than 10,000 colonies per cubic millimeter of gram-positive microorganisms. Trimethoprim–sulfamethoxazole was prescribed, and the patient . . .