Diabetes, fever, and flank pain.

Accepted 20 August 1997 A 54-year-old noninsulin-dependent diabetic woman presented with fever and left flank pain of one-month duration. She denied haematuria, gravelluria or oliguria. At presentation, she was febrile (body temperature 39°C), drowsy and dehydrated. Her pulse was 100 beats/min and blood pressure 100/70 mmHg. An indistinct tender mass was palpable in her left lumbar region. Other systemic examinations were normal. Investigations: total leucocyte count 28x109/l with 80% polymorphs, blood glucose 14 mmol/l, urea 42.6 mmol/l, creatinine 342 umol/l and pH 7.36. Urine showed 10-15 pus cells/hpf, glucosuria (++) and ketonuria (+). Urine and blood cultures were sterile. Ultrasound-guided aspiration of the mass was carried out. The aspirate was cultured and sensitivity of micro-organisms tested. Contrast-enhanced computed tomography (CT) of the abdomen is shown in the figure.