Bilateral Renal Cortical Abscesses Presenting as Pyrexia of Unknown Origin in an Immunocompetent Individual

The diagnosis of renal cortical abscess can be missed as the condition is frequently associated with blood and urine culture negativity. Moreover, imaging by ultrasonography in the early stages of the disease may miss small or developing abscesses and carbuncles. Renal abscesses being more common in the immunosuppressed, the condition may be overlooked in the immunocompetent. We report a case of bilateral renal cortical abscesses in an immunocompetent individual who presented to us with Pyrexia of Unknown Origin (PUO). The patient’s urine and blood culture were negative and initial ultrasonography of the abdomen revealed no abnormality. Based on clinical suspicion a repeat ultrasonography was done, which detected bilateral renal cortical abscesses. Thus, when in doubt repeat or more sensitive imaging is required for correct diagnosis. Important differences exist between renal cortical and cortico-medullary abscesses and this awareness guides therapeutic decision. Missing a renal cortical abscess based on single negative imaging could be catastrophic.