Posters
Presenting Author Academic/Professional Position
Aun Bangash
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Discipline Track
Community/Public Health
Abstract Type
Case Report
Abstract
Introduction: Acute pyelonephritis is a bacterial infection of the renal parenchyma and is most commonly caused by Escherichia coli. It presents with systemic and genitourinary symptoms such as fever, flank pain, and urinary abnormalities, which include increased urinary frequency and burning sensation upon urination. Timely antibiotic therapy is necessary to avoid complications like renal abscesses or urosepsis. Empiric treatment often involves third-generation cephalosporins such as ceftriaxone because of their efficacy and renal penetration. However, in patients allergic to ceftriaxone, an allergy seen in approximately 1–2% of cases, alternative regimens need to be brought into the picture. Levofloxacin, a fluoroquinolone, is an effective oral and intravenous option with good renal tissue penetration and broad-spectrum activity against uropathogens. It is particularly useful in outpatient settings and for step-down therapy. However, resistance rates and individual risk factors must be considered prior to prescribing any antimicrobial drug. Antibiotic selection should always be guided by culture sensitivity, allergy profile, and local resistance patterns to ensure both efficacy and safety in treatment.
Case Presentation: A 26-year-old woman with poorly controlled type 1 diabetes (HbA1c 11.9%) and a recent diagnosis of pyelonephritis 3 weeks ago presented to the emergency department with worsening right flank pain and body aches, resembling her prior infectious episode. She denied any urinary symptoms and point of care urinalysis was negative for leukocyte esterase and nitrites. Upon examination, she was febrile (38.5 °C), tachycardic (116 bpm), and hypertensive (154/89 mmHg). A CT scan revealed a 3.6 cm lobar nephronia on the left and early right-sided pyelonephritis. Her medical record charted a history of angioedema and urticaria with ceftriaxone (Rocephin). Given her documented ceftriaxone allergy and the risk of cross-reactivity with other beta lactam antibiotics, levofloxacin 750 mg orally once daily for 7 days was initiated. Levofloxacin is a fluoroquinolone antibiotic that is effective against common genitourinary pathogens, including Escherichia coli, and is commonly used in the treatment of pyelonephritis. Subsequently, the patient developed euglycemic diabetic ketoacidosis (eDKA), a rare but serious complication characterized by anion gap metabolic acidosis and ketosis without significant hyperglycemia. Contributing factors included her underlying infection and poorly controlled diabetes. She was transferred to the ICU for careful monitoring and management, which included intravenous insulin, dextrose-containing fluids, and electrolyte supplementation. Although she is still in the ICU, her condition has improved with appropriate therapy. Laboratory findings revealed elevated white blood cell count (10.3 ×10³/µL) with neutrophilia (83.0%), indicating an active infection. Electrolyte abnormalities included low sodium (129 mmol/L), low chloride (96 mmol/L), and low bicarbonate (18 mmol/L), consistent with anion-gap metabolic acidosis. Urinalysis showed ketonuria (>150 mg/dL) and glucosuria (>1000 mg/dL), supporting the diagnosis of eDKA. These findings highlight the importance of recognizing eDKA, especially in the presence of infection and poorly controlled diabetes.
Conclusion: This case underscores the importance of individualized antibiotic selection in treating acute pyelonephritis, particularly in patients with documented drug allergies. While ceftriaxone remains a firstline agent, alternatives like levofloxacin are crucial when contraindications exist. Additionally, this case highlights the complexity of infection management in patients with poorly controlled diabetes., including the risk of eDKA. Early recognition and prompt treatment of eDKA are vital to prevent adverse outcomes. This case emphasizes the need for prompt diagnosis, tailored antibiotic therapy, and vigilant monitoring to ensure lasting and optimal patient outcomes.
Presentation Type
Poster
Recommended Citation
Bangash, Aun Ali; Bangash, Muhammad Ali; and Martinez, Ruben Meza, "A Delicate Balance: Antibiotic Allergy, Renal Infection, and Diabetic Ketoacidosis" (2025). Research Colloquium. 12.
https://scholarworks.utrgv.edu/colloquium/2025/posters/12
Included in
A Delicate Balance: Antibiotic Allergy, Renal Infection, and Diabetic Ketoacidosis
Introduction: Acute pyelonephritis is a bacterial infection of the renal parenchyma and is most commonly caused by Escherichia coli. It presents with systemic and genitourinary symptoms such as fever, flank pain, and urinary abnormalities, which include increased urinary frequency and burning sensation upon urination. Timely antibiotic therapy is necessary to avoid complications like renal abscesses or urosepsis. Empiric treatment often involves third-generation cephalosporins such as ceftriaxone because of their efficacy and renal penetration. However, in patients allergic to ceftriaxone, an allergy seen in approximately 1–2% of cases, alternative regimens need to be brought into the picture. Levofloxacin, a fluoroquinolone, is an effective oral and intravenous option with good renal tissue penetration and broad-spectrum activity against uropathogens. It is particularly useful in outpatient settings and for step-down therapy. However, resistance rates and individual risk factors must be considered prior to prescribing any antimicrobial drug. Antibiotic selection should always be guided by culture sensitivity, allergy profile, and local resistance patterns to ensure both efficacy and safety in treatment.
Case Presentation: A 26-year-old woman with poorly controlled type 1 diabetes (HbA1c 11.9%) and a recent diagnosis of pyelonephritis 3 weeks ago presented to the emergency department with worsening right flank pain and body aches, resembling her prior infectious episode. She denied any urinary symptoms and point of care urinalysis was negative for leukocyte esterase and nitrites. Upon examination, she was febrile (38.5 °C), tachycardic (116 bpm), and hypertensive (154/89 mmHg). A CT scan revealed a 3.6 cm lobar nephronia on the left and early right-sided pyelonephritis. Her medical record charted a history of angioedema and urticaria with ceftriaxone (Rocephin). Given her documented ceftriaxone allergy and the risk of cross-reactivity with other beta lactam antibiotics, levofloxacin 750 mg orally once daily for 7 days was initiated. Levofloxacin is a fluoroquinolone antibiotic that is effective against common genitourinary pathogens, including Escherichia coli, and is commonly used in the treatment of pyelonephritis. Subsequently, the patient developed euglycemic diabetic ketoacidosis (eDKA), a rare but serious complication characterized by anion gap metabolic acidosis and ketosis without significant hyperglycemia. Contributing factors included her underlying infection and poorly controlled diabetes. She was transferred to the ICU for careful monitoring and management, which included intravenous insulin, dextrose-containing fluids, and electrolyte supplementation. Although she is still in the ICU, her condition has improved with appropriate therapy. Laboratory findings revealed elevated white blood cell count (10.3 ×10³/µL) with neutrophilia (83.0%), indicating an active infection. Electrolyte abnormalities included low sodium (129 mmol/L), low chloride (96 mmol/L), and low bicarbonate (18 mmol/L), consistent with anion-gap metabolic acidosis. Urinalysis showed ketonuria (>150 mg/dL) and glucosuria (>1000 mg/dL), supporting the diagnosis of eDKA. These findings highlight the importance of recognizing eDKA, especially in the presence of infection and poorly controlled diabetes.
Conclusion: This case underscores the importance of individualized antibiotic selection in treating acute pyelonephritis, particularly in patients with documented drug allergies. While ceftriaxone remains a firstline agent, alternatives like levofloxacin are crucial when contraindications exist. Additionally, this case highlights the complexity of infection management in patients with poorly controlled diabetes., including the risk of eDKA. Early recognition and prompt treatment of eDKA are vital to prevent adverse outcomes. This case emphasizes the need for prompt diagnosis, tailored antibiotic therapy, and vigilant monitoring to ensure lasting and optimal patient outcomes.
