Give a presentation for class with this case study. Include 3characters patient doctor and diagnosis
Case 1: Acute Pyelonephritis
A Clinical Case Study Presentation
Cast of Characters
| Character | Role |
|---|---|
| Sofia | Patient — 22-year-old female medical student |
| Dr. Reyes | Attending Physician — Outpatient Clinic |
| E. coli | The "Villain" — the pathogen behind the diagnosis |
SCENE 1 — The Patient Arrives
[Sofia enters the clinic, visibly unwell — pale, sweating, holding her right side]
Sofia: "Doctor, I've felt terrible for two days. I have a fever that hit 39.2°C, shaking chills, and this constant pain in my right side that gets worse when I move. I'm also running to the bathroom constantly and it burns every time. I can barely eat anything."
Dr. Reyes: (examining Sofia) "Let me check your vitals. Heart rate 110, BP 115/70, respiratory rate 20. You look acutely ill. I'm going to press here on your lower back — tell me if it hurts."
Sofia: (wincing sharply) "Yes! Right there!"
Dr. Reyes: "That's a positive costovertebral angle tenderness — also called Pasternatsky's sign. That's significant. The left side is fine. No suprapubic pain, lungs are clear."
SCENE 2 — The Differential Diagnosis
[Dr. Reyes steps to the side and addresses the class]
Dr. Reyes: "Based on what Sofia has told me and what I found on exam, I'm considering three possible diagnoses:"
| # | Differential | Key Feature |
|---|---|---|
| 1 | Acute Pyelonephritis | Fever + flank pain + urinary symptoms |
| 2 | Urolithiasis with obstruction | Flank pain, but usually colicky and radiating |
| 3 | Lower UTI (cystitis) | Burning + frequency, but no systemic fever/flank pain |
Dr. Reyes: "I'm ordering labs and imaging to confirm: CBC, CRP, procalcitonin, urinalysis, urine culture with susceptibility testing, and a renal ultrasound."
SCENE 3 — Enter the Villain
[Spotlight on "E. coli" — introduced as the third character]
E. coli: (narrated/announced) "I am Escherichia coli — the cause of over 80% of acute pyelonephritis cases. I ascended from the lower urinary tract, colonized Sofia's right kidney, and I've been causing havoc ever since. But I have a weakness... ceftriaxone."
SCENE 4 — The Lab Results Come In
[Dr. Reyes reviews the results]
Dr. Reyes: "Here's what the labs show:"
| Test | Result | Significance |
|---|---|---|
| WBC | 15 × 10⁹/L | Leukocytosis — active infection |
| CRP | 120 mg/L | Markedly elevated — systemic inflammation |
| Procalcitonin | 0.15 ng/mL | Normal — rules out sepsis/bacteremia |
| Urinalysis | 40-50 WBC/hpf, nitrites+, bacteria++ | Classic pyuria |
| Urine Culture | E. coli >10⁵ CFU/mL | Confirmed uropathogen |
| Renal Ultrasound | Diffuse right renal parenchyma thickening, no stones, no hydronephrosis | Confirms kidney involvement |
SCENE 5 — The Diagnosis
[Dr. Reyes turns to Sofia]
Dr. Reyes: "Sofia, based on all of your results, you have Acute Uncomplicated Pyelonephritis — a bacterial infection of your right kidney caused by E. coli. The good news: no obstruction, no abscess, and it's caught early. We're going to admit you for IV antibiotics."
Sofia: "How long will this take?"
Dr. Reyes: "You'll receive ceftriaxone 1g IV twice daily. We'll also give you IV fluids to rehydrate you and acetaminophen for the fever. Most patients feel significantly better within 48 hours."
SCENE 6 — Treatment & Recovery
[48 hours later — Sofia is sitting up, looking much better]
Sofia: "The fever is gone. The pain is so much better. I actually ate breakfast this morning."
Dr. Reyes: "Excellent. The antibiogram confirmed E. coli is susceptible to ceftriaxone, so we're continuing the same antibiotic. You'll complete a 7-day IV course, then go home with oral cefixime for 3 more days."
Treatment Summary
| Intervention | Details |
|---|---|
| Empiric antibiotic | Ceftriaxone 1g IV BID |
| Confirmed antibiotic | Ceftriaxone (same, per antibiogram) |
| Step-down therapy | Oral cefixime x 3 days |
| Supportive care | IV 0.9% saline, acetaminophen |
| Hydration | Encouraged oral fluid intake |
SCENE 7 — Discharge & Follow-Up
Dr. Reyes: "Before you go, Sofia, a few important points:"
- 2 weeks post-discharge: Control urinalysis
- 1 month post-discharge: Repeat renal ultrasound
- Avoid cold exposure and maintain good hydration
- Get evaluated for chronic infection foci (dental, tonsillar)
- Complete every antibiotic dose — even if you feel better
- Return immediately if symptoms come back
Sofia: "I will. And honestly... I think I understand pyelonephritis a lot better now than I did in the textbook."
Dr. Reyes: (smiling) "That's the best way to learn it."
Summary Slide
Diagnosis: Acute Uncomplicated Pyelonephritis Pathogen: Escherichia coli (>10⁵ CFU/mL) Key Signs: Fever, CVA tenderness, positive Pasternatsky's sign, pyuria Treatment: Ceftriaxone IV x 7 days → Cefixime PO x 3 days Outcome: Full recovery within 48 hours of treatment initiation
End of Presentation
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