First documented extended-spectrum β-lactamase producing Escherichia coli renal abscess in Lebanon: a case report.

Introduction and importance: Renal abscesses in children are rare, and those caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli are even rarer. This report presents the first case of an ESBL-producing E. coli renal abscess via a possible ascending route in a previously healthy child in Lebanon. Case presentation: A 10-year-old girl presented with high-grade fever, abdominal pain, and vomiting. Urine culture revealed an ESBL-producing E. coli infection, and imaging revealed multiple abscesses in the right kidney. Despite antibiotic treatment, the fever persisted, with abscess >3 cm requiring percutaneous drainage. After this procedure, the patient improved and was discharged with antibiotics. Follow-up imaging confirmed full resolution of all abscesses, and the voiding cystourethrogram was negative. Clinical discussion: Clinical diagnosis of a renal abscess in a previously healthy child without structural abnormalities or recent antibiotic use requires a high index of suspicion. Based on the literature and our case, we propose a diagnostic and management algorithm to guide evaluation and treatment. Conclusion: This case highlights the challenges of diagnosing and treating pediatric renal abscesses caused by ESBL-producing bacteria, marking the first reported case in Lebanon. The algorithm proposed is clinically useful but requires further validation in larger cohorts.