Ms. Phong had a history of type 2 diabetes, hypertension, and chronic ischemic heart disease. She had been self-medicating and had not had regular check-ups for many months.

Laboratory tests revealed elevated white blood cell count and inflammatory markers. Specifically, her C-reactive protein (CRP) level was over 223 mg/L, approximately 45 times the normal level of under 5 mg/L.

A chest X-ray showed scattered interstitial thickening in both lungs. Master of Science, Specialist Doctor Level II Nguyen Hoang Tuan Vu, Deputy Head of the General Internal Medicine Department at Tam Anh General Hospital Ho Chi Minh City (TP HCM), initially suspected severe pneumonia with a systemic inflammatory response. He ordered urine tests, which confirmed a urinary tract infection. Her HbA1c, reflecting average blood sugar over three months, was over 8%, indicating poorly controlled blood sugar over an extended period. This poor control increases the risk of infection and severe complications.

A subsequent computed tomography (CT) scan definitively identified bilateral pyelonephritis and renal abscesses, along with inflammation and thickening of the renal pelvis wall and the proximal left ureter. Doctor Vu stated, "This was the primary cause of the systemic infection."

Doctor Vu advises the patient on managing underlying conditions during a follow-up visit. *Photo: Tam Anh General Hospital*

A renal abscess is a collection of pus that forms within the kidney parenchyma due to bacterial invasion and growth. This condition often develops after a urinary tract infection that was either undetected or inadequately treated. Individuals with diabetes, hypertension, the elderly, or those with weakened immune systems are at high risk for this complication.

The patient received inpatient medical treatment, including intravenous broad-spectrum antibiotics and close monitoring. Her symptoms of fever, shortness of breath, and frequent urination significantly improved. Her white blood cell count returned to near normal levels, and procalcitonin, a marker for severe infection, decreased. Ms. Phong's appetite improved, her fever resolved, and her kidney function was preserved.

According to Doctor Vu, this case highlights that many dangerous infections do not always present with typical symptoms. The patient was hospitalized for high fever and shortness of breath, but the actual source of infection originated from the urinary system. Doctor Vu emphasized, "If treatment focuses only on initial symptoms and misses the primary infection site, the infection can persist, spread, and lead to numerous complications."

Doctor Vu also advised that elderly individuals and those with diabetes, hypertension, or other chronic conditions should undergo regular health check-ups. Effective management of blood sugar and blood pressure, along with early detection of abnormalities, helps reduce the risk of severe infections and prevents many dangerous complications.

Nhat Thanh

*Patient's name has been changed