Serial Hematologic-Inflammatory and Electrolyte Course in an 18-Month-Old Boy With Febrile Urinary Tract Infection and Kikiros Grade 5 Phimosis: A Single-Patient Case Study

Abstract

Background: Febrile urinary tract infection (UTI) in an uncircumcised toddler can coexist with severe preputial stenosis, which raises resistance to voiding outflow.

Objective: To describe the clinical, hematologic-inflammatory and electrolyte course of an 18-month-old boy with febrile UTI and Kikiros Grade 5 phimosis over four hospital days.

Methods: This single-patient case study, reported to the CARE guideline, covers an uncircumcised boy treated at K.R.M.T. Wongsonegoro Regional Hospital, Semarang, Indonesia, from January 31 to February 3, 2026. He presented after 3 days of antipyretic-refractory fever (38.6 °C) with vomiting, sunken eyes, obstructive voiding distress and Kikiros Grade 5 phimosis. Vital signs and blood counts were tabulated, with one chemistry panel. No inferential statistics were used.

Results: Urinalysis showed leukocyturia, bacteriuria and proteinuria. Leukocytes at admission were 10.4 × 10³/μL, hemoglobin 11.4 g/dL, hematocrit 33.10% and platelets 312 × 10³/μL. On Day 3, C-reactive protein was 16.80 mg/L, globulin 4.0 g/dL, potassium 5.50 mmol/L, sodium 136 mmol/L and ionized calcium 1.19 mmol/L. He received eight agents, including ceftriaxone, dexamethasone and furosemide. Temperature fell to 36.8 °C and heart rate from 136 to 104 beats/min. Leukocytes fell to 5.1 and then settled at 8.3 × 10³/μL, while platelets rose from 191 to 323 × 10³/μL. Voiding symptoms had resolved by Day 4.

Conclusion: In this child, symptoms and inflammatory markers improved within four days of combined treatment, and no single agent can be credited. Genital examination in febrile boys, renal ultrasonography after discharge and topical corticosteroid therapy for phimosis are advisable.