53/Female Presented with severe left Lumbar pain. History of Constipation, Dysuria. Known case of DM on Insulin but sugar not on Control CT abdomen done S/O: Hepatomegaly Bulky Cervix with Pelvic Lymph Nodes Enlarged Left Kindly with Fat Strandings S/O: Pyelonephritis Few retrperitoneal amd Inguinal Lymphnodes (+) Attached the Report and Film Kindly Guide Management and Further Treatment

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Left lumbar pain is due to Pyelonephritis. Few retroperitoneal and inguinal lymph nodes with with bulky uterus and inguinal lymph nodes are suspicious of a uterine malignancy. A cervix examination with pap smear or biopsy from a doubtful area is indicated for further evaluation. Also rule out genito urinary tuberculosis

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Case of ac pyelonephritis Urine complete exam Urine culture and sensitivity Rx Strict control of diabetes Antibiotics ....Fluoroquinolenes Levoflox Ciprofloxacin Ampicillin Sulpha gp If severe inf hematuria or pyouria Inj can be given Usually pt is asymptomatic in 2 wks Pap smear to rule out cx ca If left untreated ch inf may cause serious problems like nephrectomy

Agree @Dr. Sunila Arya
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Its a case of acute pyelonephritis.Complete history alongwith routine examination needs to be done.Antibiotics such as ciprofloxacin needs to be started.The treatment should be started as soon as possible.

Tight control of DM with insulin is paramount URINE culture and sensitivity, CBNATT, to be done .Pyelinephritis should be treated with suitable antibiotics GYNEC examination, and biopsy from cervix uterus to be done . Check RFT , and urine Protein Creatinine Ratio, to assess renal function. Supportive management

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case of- fatty liver,a/c pylonephritis, PID, to r/o cervical malignancy., uncontrolled BSL .

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Simple dm pyelonephritis.. treat with antibiotics.. n sugar control.. repeat usg after 3 weeks..no improvement or hdun.. points towards drainage of system...

Bulky cx with retriperitoneal lymph nodes indicate possibility of ca cx with metastasis hydronephrosis with pyelonephritis may be because of the parametrisl involvement and uretral obstruction.cervical punch biopsy with endocervical and endometrial curettings may be diagnostic,while treating UTI , and diabetes

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