Usually the disease is recognized when an alcoholic presents with the classic triad
1) As evident in our case, radiological evidence of RPF on IV urography includes a classic triad
of upper ureteral hydronephrosis, medial deviation of the ureters and extrinsic ureteral compression.
The preferable approach is to begin with the antibiotics and then follow-up with the confirmatory studies when acute bacterial meningitis is suspected, as in patients with the classic triad
of neck stiffness, altered mental status, and fever.
Despite the classic triad
of mouth, hand, and foot lesions, most cases are probably undiagnosed due to the benign, short course.