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Prolonged fever as a harbinger: the diagnostic and therapeutic challenge of recurrent complicated urinary tract infection following congenital dermal sinus excision in an infant: a case report

Year: 2026

Type: article

Abstract: Background: Congenital dermal sinus (CDS) is a rare form of occult spinal dysraphism. Although neurological deterioration is well recognized, postoperative neurogenic bladder and subsequent recurrent complicated urinary tract infection (rcUTI) in infants are less well described. Case presentation: A 9-month-and-26-day-old girl presented with 4 weeks of intermittent fever followed by acute paraplegia. MRI revealed a CDS with an infected intradural epidermoid cyst, which was resected. Postoperatively, she developed a neurogenic bladder requiring catheterization. Sequential urine cultures revealed Klebsiella aerogenes, fluconazole-resistant Candida glabrata (evolving from dose-dependent susceptibility), and multidrug-resistant Enterococcus faecium, accompanied by bladder stones and hydronephrosis. Blood cultures were negative on multiple occasions, with no bacterial growth for 5 consecutive days. A prolonged, susceptibility-guided antimicrobial regimen plus stone removal achieved sterilization. However, several positive urine cultures represented colonization rather than true infection; this is discussed as a cautionary antimicrobial-stewardship narrative. Conclusions: Three key conclusions emerged. First, prolonged fever without neurological signs may be an early indication of CDS. Second, neurogenic bladder following lumbosacral CDS can drive recurrent complicated UTI involving sequential bacterial and fungal pathogens. Third, successful rescue requires a multidisciplinary, prolonged, source-control-based strategy. This report adds to the limited literature by documenting detailed serial microbiological follow-up after CDS surgery. The emergence of fluconazole resistance in C. glabrata may have been promoted by treating colonization, highlighting the need for strict UTI definitions in catheterized infants.

Source: Frontiers in Pediatrics

DOI: 10.3389/fped.2026.1900708

Authors: Lihui Liao, Wentao Peng

Institutions: Sichuan University, West China Second University Hospital of Sichuan University

Language: English

Topic: Urinary Tract Infections Management

Subfield: Urology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801