Norma Bosman, Nelesh P Govender
An 11-year-old boy presented to the paediatric oncology outpatient clinic on 1 September 2014 with fever and back pain.
He was known to the clinic, and had been previously diagnosed with acute lymphoblastic leukaemia (ALL) in 2006.He had been in remission and off treatment since December 2009, but later relapsed in January 2012, and was restarted on chemotherapy.
He was admitted and started on a combination of IV piperacillin-tazobactam, amikacin and vancomycin. Laboratory samples, including blood culture, were submitted prior to starting antibiotics. Chemotherapy was discontinued temporarily. His admission neutrophil count was 2.9 x 109 cells/L (reference range: 1.40 – 5.20 x 109 cells/L).
An abdominal CT scan done 2 days later revealed a left renal abscess. Six months prior to this admission, the patient had had a pigtail catheter inserted for the drainage of an abscess in the same kidney. No pus samples had been submitted to the laboratory during the previous admission.